Addition of clopidogrel versus cilostazol in acute ischemic stroke patients while on aspirin therapy

Antiplatelet therapy is the cornerstone for the secondary prevention in acute ischemic stroke. Aspirin was considered first-line therapy for secondary prevention in patients with atherothrombotic stroke. However, several studies actually found that aspirin alone did not significantly regulate platelet activation or aggregation in acute ischemic stroke. Thus, a rational approach, to augment this relatively weak inhibitory effects, is to combine it with an anti-platelet agent with a different mechanism of action. This study compared the efficacy and safety of dual antiplatelet therapy of aspirin and clopidogrel versus aspirin and cilostazol in noncardioembolic stroke patients who were on current aspirin therapy admission. 60 patients with acute ischemic stroke were randomized to receive either aspirin (162 mg/d) plus clopidogrel (75 mg/d) or aspirin (162 mg/d) plus cilostazol (200 mg/d)for six months. The antiplatelet effect of dual therapy was monitored by measuring Pselectin and PAC-1 expression before and after 7days of therapy. The clinical efficacy was assessed using National Institute of Health Stroke Scale and modified Rankin Scale. The composite clinical endpoint (death, recurrent stroke, hemorrhagic complications, hemorrhagic transformation), was used to assess the safety of the two treatment strategies. Both regimens were similarly effective in significantly reducing P-selectin and PAC-1 expressions in the acute phase of ischemic stroke. Patients on both regimens showed a significant improvement in the neurological and functional outcome during the hospitalization period with no significant difference. A non significant higher incidence of hemorrhagic complications and recurrent stroke was encountered among patients on aspirin plus clopidogrel therapy than those on aspirin plus cilostazol therapy. Dual antiplatelet therapy of either aspirin plus clopidogrel or aspirin plus cilostazol was effective in improving the therapeutic outcomes of patients admitted with acute ischemic stroke while on current aspirin therapy.