What is the clinical evidence from this study?

Study design: Cohort. Population: Ischemic stroke with clopidogrel resistance (n=221). Intervention: Cilostazol vs. Clopidogrel (75 mg daily). Primary outcome: Recurrent ischemic stroke within 1 year (p=0.028).

What does this research mean for the field?

Switching to cilostazol significantly reduces the 1-year recurrence rate of ischemic stroke compared to continuing clopidogrel in patients with confirmed clopidogrel resistance. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to evaluate if cilostazol is more effective than clopidogrel for preventing recurrent strokes in patients resistant to clopidogrel.

April 17, 2026Open Access

Cilostazol as an alternative to clopidogrel for secondary stroke prevention in patients with ischemic stroke and clopidogrel resistance: a retrospective study

Key Result

Switching to cilostazol significantly reduced the 1-year recurrence rate of ischemic stroke to 4.8% compared to 13.0% with continued clopidogrel in patients with confirmed clopidogrel resistance.

Key Points

This study aims to evaluate if cilostazol is more effective than clopidogrel for preventing recurrent strokes in patients resistant to clopidogrel.
Retrospective analysis of patients with acute ischemic stroke from 2012 to 2021.
Patients received dual antiplatelet therapy for at least 5 days and exhibited clopidogrel resistance (P2Y12 reaction units >240).
Groups were assigned: one continuing clopidogrel, the other switched to cilostazol for one year.
Primary outcome measured was the rate of recurrent ischemic stroke within one year.
Recurrent ischemic stroke was less frequent in the cilostazol group (4.8%) compared to the clopidogrel group (13.0%) with a P-value of 0.028.
Continued clopidogrel use was identified as an independent predictor of stroke recurrence, with an odds ratio of 1.33 after adjustments.

Study Design

Type

Cohort (n=221)

Multicenter

Structured PICO

Does switching to aspirin plus cilostazol reduce recurrent ischemic stroke within 1 year compared to continuing aspirin plus clopidogrel in patients with acute ischemic stroke and clopidogrel resistance?

Population

221 patients with acute ischemic stroke who received dual antiplatelet therapy for at least 5 days and demonstrated clopidogrel resistance (defined as P2Y12 reaction units 240 on the VerifyNow assay)

Intervention

Aspirin plus cilostazol (100 mg twice daily) for 1 year

Comparator

Aspirin plus clopidogrel for 1 year

Outcome

Recurrent ischemic stroke within 1 yearhard clinical

In patients with acute ischemic stroke and clopidogrel resistance, switching to cilostazol plus aspirin significantly reduced the 1-year risk of recurrent ischemic stroke compared to continuing clopidogrel plus aspirin.

Main Result

Absolute Event Rate: 4.8% vs 13%

p-value: p=0.028

Limitations

Retrospective design susceptible to selection bias
Single-center study limiting generalizability
Patients were not stratified based on detailed vascular anatomical features
Non-randomized nature requires cautious interpretation
Important clinical confounders such as stroke subtypes, comorbid systemic atherosclerosis, and long-term bleeding outcomes were not comprehensively accounted for

Abstract

Objective: Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is a standard for secondary prevention.However, clopidogrel resistance is common in East Asian populations and may increase the risk of recurrent stroke.This study evaluated whether switching to cilostazol was more effective than continuing clopidogrel for reducing 1-year ischemic stroke recurrence in patients with confirmed clopidogrel resistance.Methods: We retrospectively analyzed patients with acute ischemic stroke who were admitted between January 2012 and December 2021.Eligible patients had received DAPT for at least 5 days and demonstrated clopidogrel resistance, defined as P2Y12 reaction units 240 on the VerifyNow assay.Patients were assigned to either the clopidogrel group (aspirin plus clopidogrel) or the cilostazol group (aspirin plus cilostazol, 100 mg twice daily).The treatment duration was 1 year in both groups.The primary outcome was recurrent ischemic stroke within 1 year.Results: Among 221 patients(138 clopidogrel, 83 cilostazol), baseline characteristics were similar.At 1 year, recurrent ischemic stroke was less frequent in the cilostazol group than in the clopidogrel group (4.8% 4/83 vs. 13.0%18/138, P = 0.028).In multivariable logistic regression analysis, continued clopidogrel use was identified as an independent predictor of recurrence after adjustment for potential confounders (odds ratio, 1.33; 95% confidence interval, 0.35-5.04;P = 0.049). Conclusion:In patients with clopidogrel resistance, switching to cilostazol may be associated with a lower 1-year recurrence rate than continuing clopidogrel.Larger prospective trials are needed.

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Cite This Study

Oh et al. (Wed,) conducted a cohort in Ischemic stroke with clopidogrel resistance (n=221). Cilostazol vs. Clopidogrel (75 mg daily) was evaluated on Recurrent ischemic stroke within 1 year (p=0.028). Switching to cilostazol significantly reduced the 1-year recurrence rate of ischemic stroke to 4.8% compared to 13.0% with continued clopidogrel in patients with confirmed clopidogrel resistance.

synapsesocial.com/papers/69e1cd6f5cdc762e9d856f5d https://doi.org/https://doi.org/10.51638/jksgn.2025.00136

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