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Antiplatelet and anticoagulant agents for secondary prevention of stroke and other thromboembolic events in people with antiphospholipid syndrome.
CONCLUSIONS: The evidence identified indicates that NOACs compared with standard-dose VKAs may increase the risk of stroke and do not appear to alter the risk of other outcomes (moderate-certainty evidence). Using high-dose VKA versus standard-dose VKA did not alter the risk of any thromboembolic event or major bleeding but may increase the risk of any form of bleeding (low-certainty evidence). Standard-dose VKA combined with an AP agent compared with standard-dose VKA alone may increase the risk of any thromboembolic event and does not appear to alter the risk of major bleeding or other outcomes (low-certainty evidence). ...
Source: Cochrane Database of Systematic Reviews - October 12, 2020 Category: General Medicine Authors: Bala MM, Celinska-Lowenhoff M, Szot W, Padjas A, Kaczmarczyk M, Swierz MJ, Undas A Tags: Cochrane Database Syst Rev Source Type: research

Adverse clinical outcomes associated with double dose clopidogrel compared to the other antiplatelet regimens in patients with coronary artery disease: a systematic review and meta-analysis.
CONCLUSIONS: In patients with CAD, adverse clinical outcomes were not significantly different when DDC was compared to the other antiplatelet regimens. In addition, bleeding events were also similarly manifested when DDC was compared to DAPT, TAPT or ticagrelor/prasugrel. PMID: 30176938 [PubMed - in process]
Source: BMC Pharmacology and Toxicology - September 5, 2018 Category: Drugs & Pharmacology Tags: BMC Pharmacol Toxicol Source Type: research

Randomized Comparisons of Double-Dose Clopidogrel or Adjunctive Cilostazol versus Standard Dual Anti-platelet in Patients with High Post-Treatment Platelet Reactivity: Results of the CREATIVE Trial (Clopidogrel Response Evaluation and AnTi-platelet InterVEntion in High Thrombotic Risk PCI Patients).
Conclusions -In patients with low responsiveness to clopidogrel, as measured by thromboelastography, the intensified antiplatelet strategies with adjunctive use of cilostazol significantly improved the clinical outcomes without increasing the risk of major bleeding. Decreased trend of negative outcomes could be observed in patients with double dosage of clopidogrel, but the difference was not significant. Clinical Trial Registration -URL: http://www.clinicaltrials.gov Unique Identifier: NCT01779401. PMID: 29420189 [PubMed - as supplied by publisher]
Source: Circulation - February 2, 2018 Category: Cardiology Authors: Tang YD, Wang W, Yang M, Zhang K, Chen J, Qiao S, Yan H, Wu Y, Huang X, Xu B, Gao R, Yang Y, CREATIVE investigators Tags: Circulation Source Type: research

Is there a role for oral triple therapy in patients with acute coronary syndromes without atrial fibrillation?
CONCLUSION: More potent antithrombotic regimens increase bleeding and should only be considered on an individual basis, after careful risk stratification. Accurate risk stratification of ACS patients, for both ischaemic and bleeding risk, is essential to allow individualised treatment. PMID: 29345587 [PubMed - as supplied by publisher]
Source: Current Vascular Pharmacology - January 16, 2018 Category: Drugs & Pharmacology Authors: Spinthakis N, Farag M, Akhtar Z, Gorog DA Tags: Curr Vasc Pharmacol Source Type: research

Antithrombotic Therapy.
Authors: Kwon SU, Kim JS Abstract Symptomatic cerebral atherosclerosis including intracranial atherosclerosis (ICAS) is associated with a high risk of recurrent stroke. Antithrombotic agents are the mainstay of therapy in these patients. Several studies have found anticoagulation (warfarin) to increase the risk of bleeding events and have an efficacy no better than that of aspirin. Therefore, anticoagulants are not widely used unless patients develop recurrent ischemic symptoms despite receiving antiplatelet therapy. Because ICAS progression is not uncommon and the risk of stroke recurrence is high when aspirin mon...
Source: Frontiers of Neurology and Neuroscience - December 15, 2016 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

Protective effects of cilostazol against hemorrhagic stroke: Current and future perspectives
Publication date: Available online 3 May 2016 Source:Journal of Pharmacological Sciences Author(s): Toshinori Takagi, Hideaki Hara Cilostazol is a phosphodiesterase-3 inhibitor and is known to have pleiotropic effects including antiplatelet and vasodilatation effects and protective effects on endothelial cells. Cilostazol also reportedly reduced stroke recurrence, poststroke intracranial hemorrhaging, and extracranial bleeding in a meta-analysis. Although it is known that cilostazol has the potential to suppress hemorrhagic stroke, the precise mechanisms remained unclear. Therefore, we evaluated the protective effects ...
Source: Journal of Pharmacological Sciences - June 15, 2016 Category: Drugs & Pharmacology Source Type: research

Meta-Analysis of Studies Evaluating the Effect of Cilostazol on Major Outcomes After Carotid Stenting
Conclusion: Cilostazol seems to decrease total ISR rates in patients undergoing CAS without affecting MI/stroke/death events, both in the early and late settings.
Source: Journal of Endovascular Therapy - January 12, 2016 Category: Surgery Authors: Galyfos, G., Geropapas, G., Sigala, F., Aggeli, K., Sianou, A., Filis, K. Tags: Carotid Artery Stenting Source Type: research

Optimal- vs. standard-antiplatelet therapy on platelet function and long-term clinical outcomes in patients with high on-treatment platelet reactivity: 2-year outcomes of the multicentre, randomized Optimal-antiPlatelet Therapy (OPT) trial
Optimal strategy for the management of high on-treatment platelet reactivity (HPR), an independent predictor of ischaemic events, is not yet clear. The aim of this study was to explore the safety and efficacy of personalized antiplatelet therapy based on platelet function testing in patients with HPR. A total of 840 patients with HPR who underwent coronary stenting for acute coronary syndrome (ACS) were randomly assigned in a 1:2 ratio to receive standard dual-antiplatelet therapy (n = 280) or platelet function-guided optimal-antiplatelet therapy (n = 560). In the optimal group, patients initially received clopidogrel 150 ...
Source: European Journal of Heart Failure Supplements - March 23, 2015 Category: Cardiology Authors: Li, Y., Han, Y., Guan, S., Sun, Y., Guo, L., Yang, B., Zang, H., Jing, Q., Wang, X., Ma, Y., Liu, X., Li, J., Zheng, L. Tags: Articles Source Type: research

Cilostazol research in Asia: can it be applied to European and American patients?
Cilostazol is an antiplatelet drug often used in Asian countries like Korea, Japan, and China. However, it is rarely used in the west. Cilostazol inhibits phosphodiesterase, increases cyclic AMP concentrations, and consequently inhibits platelet aggregation. Interestingly, it also has vasodilatory activity, inhibits vascular smooth muscle proliferation, and protects the endothelium. Studies in Asia have shown that cilostazol is effective in the secondary prevention of stroke. Moreover, it is significantly less likely to cause bleeding complications than aspirin. Additional trials have shown that cilostazol is effective in ...
Source: International Journal of Stroke - March 4, 2015 Category: Neurology Authors: Jong S. Kim, Sun U. Kwon, Shinichiro Uchiyama Tags: Leading Opinion (Invited) Source Type: research

Efficacy and safety of cilostazol based triple antiplatelet treatment versus dual antiplatelet treatment in patients undergoing coronary stent implantation: an updated meta-analysis of the randomized controlled trials
Abstract The aim of this study was to obtain best estimates of the efficacy and safety of cilostazol-based triple antiplatelet therapy (TAPT: aspirin, clopidogrel and cilostazol) compared with dual antiplatelet therapy (DAPT: aspirin and clopidogrel) in patients undergoing coronary stent implantation. We searched the literature to identify all randomized clinical trials examining efficacy and safety of TAPT versus DAPT in patients undergoing coronary stent implantation. Major efficacy outcomes were death, non-fatal myocardial infarction (MI), ischemic stroke and stent thrombosis (ST) and the safety outcome was bl...
Source: Journal of Thrombosis and Thrombolysis - January 1, 2015 Category: Hematology Source Type: research

Protocol for Cilostazol Stroke Prevention Study for Antiplatelet Combination (CSPS.com): a randomized, open‐label, parallel‐group trial
DiscussionThe CSPS.com is expected to provide evidence indicating whether secondary IS prevention in high‐risk patients can be improved by using DAPT involving cilostazol.
Source: International Journal of Stroke - December 8, 2014 Category: Neurology Authors: Kazunori Toyoda, Shinichiro Uchiyama, Haruhiko Hoshino, Kazumi Kimura, Hideki Origasa, Hiroaki Naritomi, Kazuo Minematsu, Takenori Yamaguchi, Tags: Protocols Source Type: research

The efficacy and safety of cilostazol in ischemic stroke patients with peripheral arterial disease (SPAD): protocol of a randomized, double‐blind, placebo‐controlled multicenter trial
ConclusionThe SPAD trial is the first study to evaluate the safety and efficacy of dual antiplatelet agents, aspirin plus cilostazol, in comparison with aspirin alone in patients with both ischemic stroke or TIA and PAD. Results from this trial will provide important information on the merit of adding cilostazol to aspirin for slowing down progression of atherosclerosis in patients with ischemic stroke and PAD.
Source: International Journal of Stroke - November 14, 2014 Category: Neurology Authors: Jiann‐Shing Jeng, Yu Sun, Jiunn‐Tay Lee, Ruey‐Tay Lin, Chih‐Hung Chen, Helen L. Po, Huey‐Juan Lin, Chung‐Hsiang Liu, Ming‐Hui Sun, Mu‐Chien Sun, Chang‐Ming Chern, Li‐Ming Lien, Hou‐Chang Chiu, Han‐Hwa Hu, Hung‐Yi Chiou, Sien‐Ts Tags: Protocols Source Type: research

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