Effect of oral cilostazol on acute neurological deterioration and outcome of noncardioembolic minor stroke

Background/Purpose Stroke recurrence in the acute phase is not rare, even in minor stroke patients. We investigated whether combined antithrombotic therapy with early oral cilostazol prevents progressive stroke and improves outcomes in ischemic stroke patients. Methods For the present study, 311 first-time stroke patients who were admitted within 48 hours after the onset and were diagnosed as having a noncardioembolic stroke with National Institutes of Health Stroke Scale (NIHSS) scores of ≤ 7 were prospectively included. All patients were classified into two groups according to oral cilostazol. In Group A, 154 patients were treated with conventional antithrombotic agents with or without oral aspirin (100-200 mg/d), during the first 7 hospital days. In Group C, 157 patients were treated with oral cilostazol 200 mg/d (100 mg twice daily) plus conventional antithrombotic agents during the first 7 hospital days. Neurological deterioration during the first 21 days, stroke recurrence, cardiovascular events, and any deaths during a 3-month follow-up period were compared between Groups A and C. Results The frequencies of neurological deterioration, stroke recurrence, acute myocardial infarction, or death from all causes did not differ between Groups A and C. A good outcome at 3 months after admission was observed more frequently in Group C than in Group A patients (68% vs. 56%, p = 0.0253). In the multivariate analysis, age [odds ratio (OR), 0.94; 95% confidence interval (CI), 0.91-0.97; p < 0.0001] and initial NIHSS score (OR, 0.65; 95% CI, 0.56-0.76; p < 0.0001) were negatively associated, and cilostazol (OR, 1.99; 95% CI, 1.05-3.77; p = 0.0353) was positively associated with a good outcome. Conclusion In noncardioembolic stroke, combined antithrombotic therapy with early oral cilostazol in the acute phase appears to be associated with a good outcome in patients with progressive stroke.