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Our previous trial acute dual study (ADS) reported that dual antiplatelet therapy (DAPT) using cilostazol and aspirin did not reduce the rate of short-term neurological worsening in non-cardioembolic stroke patients. Present post-hoc analysis investigated whether the impact of combined cilostazol and aspirin differed among stroke subtypes and factors associated with neurological deterioration and/or stroke recurrence. Using the ADS registry, the rate of neurological deterioration, defined as clinical worsening and/or recurrent stroke, including transient ischemic attack was calculated. Stroke subtypes included large-artery atherosclerosis (LAA), small vessel occlusion (SVO), other determined etiology (Others), and undetermined etiology of stroke (Undetermined). Data of 1022 patients were analyzed. Deterioration was seen in 104 (10%) patients, and the rates were not markedly different between patients treated with DAPT vs. aspirin in any stroke subtypes: LAA, 19% vs. 11%, (p=0.192); SVO, 10% vs. 10% (p=1.000); Others, 6% vs. 6% (p=1.000); Undetermined, 11% vs. 8% (p=0.590). Diabetes mellitus was the independent factor associated with deterioration (odds ratio 4.360, 95% confidence interval 1.139-16.691, p=0.032) in the LAA group. Age (1.030 [1.004-1.057], p=0.026), systolic blood pressure (1.012 [1.003-1.022], p=0.010), and infarct size (2.550 [1.488-4.371], p=0.001) were associated with deterioration in SVO group, and intracranial stenosis/occlusion was associated with it in the Undetermined group (3.744 [1.138-12.318], p=0.030). Combined cilostazol and aspirin did not reduce the rate of short-term neurological deterioration in any clinical stroke subtype. The characteristics of patients whose condition deteriorates in the acute period may differ based on the stroke subtypes. Copyright © 2020 Elsevier Inc. All rights reserved.


Junya Aoki, Yasuyuki Iguchi, Takao Urabe, Hiroshi Yamagami, Kenichi Todo, Shigeru Fujimoto, Koji Idomari, Nobuyuki Kaneko, Takeshi Iwanaga, Tadashi Terasaki, Ryota Tanaka, Nobuaki Yamamoto, Akira Tsujino, Koichi Nomura, Koji Abe, Masaaki Uno, Yasushi Okada, Hideki Matsuoka, Sen Yamagata, Yasumasa Yamamoto, Toshiro Yonehara, Takeshi Inoue, Yoshiki Yagita, Kazumi Kimura, ADS investigators. Cilostazol Addition to Aspirin could not Reduce the Neurological Deterioration in TOAST Subtypes: ADS Post-Hoc Analysis. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2021 Feb;30(2):105494

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PMID: 33278804

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