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Fan CN, Tsai TN, Lu XJ, Lai HF, Wang CH, Chiu YL. Transcriptomic analysis reveals Cilostazol's role in ameliorating cardiovascular disease: Inhibition of monocyte-to-macrophage differentiation and reduction of endothelial cell reactive oxygen species production. Heliyon 2024; 10:e29194. [PMID: 38601627 PMCID: PMC11004659 DOI: 10.1016/j.heliyon.2024.e29194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024] Open
Abstract
Background Cardiovascular diseases (CVDs) are the leading global cause of death, with atherosclerosis as the primary cause. Chronic inflammation, endothelial dysfunction, and the role of molecules like nitric oxide and reactive oxygen species are crucial in this context. Our previous research indicated that cilostazol and ginkgo biloba extract could enhance the ability of endothelial cells to dissolve blood clots, but the effects of cilostazol on monocytes remain unexplored. Method This study utilized peripheral blood mononuclear cells from 10 healthy donors, treated ex vivo with cilostazol. RNA-sequencing, over-representation analysis, xCell stromal cell analysis, and Gene Set Enrichment Analysis were employed to investigate the gene expression changes and biological pathways affected by cilostazol treatment. Results The study identified specific gene sets and pathways that were enriched or reduced in response to cilostazol treatment, providing insights into its effects on monocytes and potential therapeutic applications in CVD. The analysis also revealed the potential impact of cilostazol on the stromal cell compartment, further broadening our understanding of its multifaceted role. Conclusion The findings offer a nuanced understanding of the advantages and mechanisms of cilostazol in CVD, uncovering novel therapeutic targets and strategies to enhance the clinical application of cilostazol and contributing to the broader implications of this therapy in cardiovascular health.
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Affiliation(s)
- Chia-Ning Fan
- Department of Surgery, Taoyuan Armed Forces General Hospital, Taoyuan, 325, Taiwan (R.O.C.)
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, 114, Taiwan (R.O.C.)
| | - Tsung-Neng Tsai
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, 114, Taiwan (R.O.C.)
| | - Xin-Jie Lu
- Department of Biochemistry, National Defense Medical Center, Taipei, 114, Taiwan (R.O.C.)
| | - Hsing-Fan Lai
- Department of Biochemistry, National Defense Medical Center, Taipei, 114, Taiwan (R.O.C.)
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei city, 114, Taiwan (R.O.C.)
| | - Chun-Hua Wang
- Department of Biochemistry, National Defense Medical Center, Taipei, 114, Taiwan (R.O.C.)
| | - Yi-Lin Chiu
- Department of Biochemistry, National Defense Medical Center, Taipei, 114, Taiwan (R.O.C.)
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2
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Uchiyama S, Toyoda K, Okamura S, Omae K, Hoshino H, Kimura K, Kitagawa K, Minematsu K, Yamaguchi T. Dual antiplatelet therapy with cilostazol in stroke patients with extracranial arterial stenosis or without arterial stenosis: A subgroup analysis of the CSPS.com trial. Int J Stroke 2023; 18:426-432. [PMID: 35762581 DOI: 10.1177/17474930221112343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We previously reported that dual antiplatelet therapy (DAPT) with cilostazol was superior to aspirin or clopidogrel for the prevention of recurrent stroke and vascular events in a subgroup analysis of intracranial arterial stenosis in the Cilostazol Stroke Prevention Study for Antiplatelet Combination (CSPS.com), a randomized controlled trial. AIMS We conducted another subgroup analysis to investigate the benefit of DAPT with cilostazol in patients with extracranial arterial stenosis (ECAS) and those without arterial stenosis. METHODS We compared the risk of recurrent ischemic stroke, vascular events, and major bleeding between DAPT with cilostazol plus aspirin or clopidogrel and aspirin or clopidogrel alone in patients with ischemic stroke between 8 and 180 days before starting trial treatment and ECAS or without arterial stenosis. RESULTS The median follow-up period was 1.4 years. The risk of recurrent ischemic stroke (hazard ratio (HR): 1.04, 95% confidence interval (CI): 0.42-2.57) and vascular events (HR: 0.97, 95% CI: 0.42-2.24) did not differ between the two groups for the 253 patients with ECAS, whereas they were lower (HR: 0.36, 95% CI: 0.18-0.74 and HR: 0.47, 95% CI: 0.26-0.85, respectively) in the DAPT group for the 944 patients without arterial stenosis. The risk of major bleeding did not differ between the groups in patients with ECAS (HR: 0.58, 95% CI: 0.05-6.39) or without arterial stenosis (HR: 0.79, 95% CI: 0.27-2.26). CONCLUSION DAPT with cilostazol might be beneficial for prevention of recurrent stroke and vascular events in patients without arterial stenosis but not in those with ECAS. DATA ACCESS STATEMENT We will make the deidentified participant data from this research available to the scientific community with as few restrictions as feasible, while retaining exclusive use until the publication of major output.
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Affiliation(s)
- Shinichiro Uchiyama
- Clinical Research Center for Medicine, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Medical Center, Tokyo, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satomi Okamura
- Department of Data Science, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Katsuhiro Omae
- Department of Data Science, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Haruhiko Hoshino
- Department of Neurology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Kazumi Kimura
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Takenori Yamaguchi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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3
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Horie Y, Horiuchi Y, Ishiyama A, Tsuchida T, Yoshimizu S, Hirasawa T, Fujisaki J, Maetani I, Yoshio T. The effect of antithrombotic drug use on delayed bleeding with esophageal endoscopic resection. J Gastroenterol Hepatol 2022; 37:1792-1800. [PMID: 35844140 DOI: 10.1111/jgh.15944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Whether antithrombotic drugs increase the risk of post-esophageal endoscopic resection bleeding is unknown. This study examined the effect of antithrombotic drugs, aspirin, thienopyridine, direct oral anticoagulants (DOAC), and warfarin, on post-esophageal endoscopic resection bleeding. METHODS We enrolled 957 patients (1202 esophageal tumors) treated with endoscopic resection and classified them based on antithrombotic drug use as no use, aspirin, thienopyridine, DOAC, and warfarin. Patients using antiplatelet drugs (i.e. aspirin and thienopyridine) were further sub-classified based on their continued or discontinued use before endoscopic resection. The bleeding rates were compared between these groups to assess the effects of antithrombotic drug use and interruption of antiplatelet therapy on post-esophageal endoscopic resection bleeding. RESULTS The post-endoscopic resection bleeding rate was 0.3% (95% CI, 0.1-1) in the group without antithrombotic drug use, 4.5% (95% CI, 0.1-23) in the aspirin-continued group, 2.9% (95% CI, 0.1-15) in the aspirin-discontinued group, 0% (95% CI, 0-78) in the replaced thienopyridine with aspirin group, 0% (95% CI, 0-26) in the thienopyridine-discontinued group, 13% (95% CI, 1.6-38) in the DOAC group, and 0% (95% CI, 0-45) in the warfarin group. The post-endoscopic resection bleeding rate in the DOAC group was significantly higher than that in the group without antithrombotic drugs (P = 0.003). The post-endoscopic resection bleeding rates did not differ between the other groups. CONCLUSIONS Our results suggest that discontinuing aspirin is not necessary for esophageal endoscopic resection while we must be careful regarding DOAC.
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Affiliation(s)
- Yoshimasa Horie
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yusuke Horiuchi
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiyoshi Ishiyama
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomohiro Tsuchida
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shoichi Yoshimizu
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiaki Hirasawa
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junko Fujisaki
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Iruru Maetani
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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4
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Cilostazol as an adjunctive treatment in major depressive disorder: a pilot randomized, double-blind, and placebo-controlled clinical trial. Psychopharmacology (Berl) 2022; 239:551-559. [PMID: 35072758 DOI: 10.1007/s00213-021-06041-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cilostazol, a phosphodiesterase-3 inhibitor, has been reported to improve depressive-like behavior in experimental studies of depression. We investigated the safety and efficacy of cilostazol combination therapy with sertraline in treating patients with major depressive disorder (MDD) in a 6-week, parallel, randomized controlled trial. METHOD Among patients referred to the outpatient clinic of a tertiary hospital, those with a diagnosis of MDD with moderate to severe severity (a score of >19 on the Hamilton depression rating scale (HAM-D)) were enrolled. A total of 54 MDD patients aged 18-65 years were randomly assigned to either the cilostazol (100 mg daily) or the placebo group. Both groups received sertraline 100 mg per day similarly. Changes in HAM-D at weeks 2, 4, and 6 were the primary outcome. Participants and outcome assessors were blinded. RESULTS At week 6, patients in the cilostazol group had significantly lower HAM-D score (p value= 0.015). General linear model repeated-measure analysis showed significant effect for treatment in improving MDD severity (p value <0.001). The remission rate at the study endpoint and number of responders at week 4 were significantly higher in the cilostazol group (p value= 0.047, p value= 0.032, respectively). The cilostazol group demonstrated a significantly shorter time to response. No significant difference was observed in treatment response at the study endpoint, and there were no serious adverse effects. CONCLUSION Our study supports safety and efficacy of cilostazol in treating MDD patients. TRIAL REGISTRATION This trial was registered at the Iranian registry of clinical trials (IRCT: www.irct.ir ; registration number: IRCT20090117001556N130).
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5
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Manolis AA, Manolis TA, Melita H, Mikhailidis DP, Manolis AS. Update on Cilostazol: A Critical Review of Its Antithrombotic and Cardiovascular Actions and Its Clinical Applications. J Clin Pharmacol 2021; 62:320-358. [PMID: 34671983 DOI: 10.1002/jcph.1988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/17/2021] [Indexed: 12/17/2022]
Abstract
Cilostazol, a phosphodiesterase III inhibitor, has vasodilating and antiplatelet properties with a low rate of bleeding complications. It has been used over the past 25 years for improving intermittent claudication in patients with peripheral artery disease (PAD). Cilostazol also has demonstrated efficacy in patients undergoing percutaneous revascularization procedures for both PAD and coronary artery disease. In addition to its antithrombotic and vasodilating actions, cilostazol also inhibits vascular smooth muscle cell proliferation via phosphodiesterase III inhibition, thus mitigating restenosis. Accumulated evidence has shown that cilostazol, due to its "pleiotropic" effects, is a useful, albeit underutilized, agent for both coronary artery disease and PAD. It is also potentially useful after ischemic stroke and is an alternative in those who are allergic or intolerant to classical antithrombotic agents (eg, aspirin or clopidogrel). These issues are herein reviewed together with the pharmacology and pharmacodynamics of cilostazol. Large studies and meta-analyses are presented and evaluated. Current guidelines are also discussed, and the spectrum of cilostazol's actions and therapeutic applications are illustrated.
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Affiliation(s)
| | | | | | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
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6
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Uchiyama S, Toyoda K, Omae K, Saita R, Kimura K, Hoshino H, Sakai N, Okada Y, Tanaka K, Origasa H, Naritomi H, Houkin K, Yamaguchi K, Isobe M, Minematsu K, Matsumoto M, Tominaga T, Tomimoto H, Terayama Y, Yasuda S, Yamaguchi T. Dual Antiplatelet Therapy Using Cilostazol in Patients With Stroke and Intracranial Arterial Stenosis. J Am Heart Assoc 2021; 10:e022575. [PMID: 34622679 PMCID: PMC8751870 DOI: 10.1161/jaha.121.022575] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Long-term benefit of dual antiplatelet therapy (DAPT) over single antiplatelet therapy (SAPT) for the prevention of recurrent stroke has not been established in patients with intracranial arterial stenosis. We compared the efficacy and safety of DAPT with cilostazol and clopidogrel or aspirin to those of SAPT with clopidogrel or aspirin in patients with intracranial arterial stenosis, who were recruited to the Cilostazol Stroke Prevention Study for Antiplatelet Combination trial, a randomized controlled trial in high-risk Japanese patients with ischemic stroke. Methods and Results We compared the vascular and hemorrhagic events between DAPT and SAPT in patients with ischemic stroke and symptomatic or asymptomatic intracranial arterial stenosis of at least 50% in a major intracranial artery. Patients were placed in two groups: 275 were assigned to receive DAPT and 272 patients SAPT. The risks of ischemic stroke (hazard ratio [HR], 0.47; 95% CI, 0.23-0.95); and composite of stroke, myocardial infarction, and vascular death (HR, 0.48; 95% CI, 0.26-0.91) were lower in DAPT than SAPT, whereas the risk of severe or life-threatening bleeding (HR, 0.72; 95% CI, 0.12-4.30) did not differ between the 2 treatment groups. Conclusions DAPT using cilostazol was superior to SAPT with clopidogrel or aspirin for the prevention of recurrent stroke and vascular events without increasing bleeding risk among patients with intracranial arterial stenosis after stroke. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01995370.
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Affiliation(s)
| | | | | | - Ryotaro Saita
- National Cerebral and Cardiovascular Center Osaka Japan
| | | | | | | | | | | | | | | | - Kiyohiro Houkin
- Hokkaido University Graduate School of Medicine Sapporo Japan
| | | | | | | | | | - Teiji Tominaga
- Tohoku University Graduate School of Medicine Sendai Japan
| | | | | | - Satoshi Yasuda
- Tohoku University Graduate School of Medicine Sendai Japan
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7
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Wardlaw J, Bath PMW, Doubal F, Heye A, Sprigg N, Woodhouse LJ, Blair G, Appleton J, Cvoro V, England T, Hassan A, John Werring D, Montgomery A. Protocol: The Lacunar Intervention Trial 2 (LACI-2). A trial of two repurposed licenced drugs to prevent progression of cerebral small vessel disease. Eur Stroke J 2020; 5:297-308. [PMID: 33072884 PMCID: PMC7538764 DOI: 10.1177/2396987320920110] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/05/2020] [Indexed: 11/17/2022] Open
Abstract
Background Small vessel disease causes a quarter of ischaemic strokes (lacunar subtype),
up to 45% of dementia either as vascular or mixed types, cognitive
impairment and physical frailty. However, there is no specific treatment to
prevent progression of small vessel disease. Aim We designed the LACunar Intervention Trial-2 (LACI-2) to test feasibility of
a large trial testing cilostazol and/or isosorbide mononitrate (ISMN) by
demonstrating adequate participant recruitment and retention in follow-up,
drug tolerability, safety and confirm outcome event rates required to power
a phase 3 trial. Methods and design LACI-2 is an investigator-initiated, prospective randomised open label
blinded endpoint (PROBE) trial aiming to recruit 400 patients with prior
lacunar syndrome due to a small subcortical infarct. We randomise
participants to cilostazol v no cilostazol and ISMN or no ISMN, minimising
on key prognostic factors. All patients receive guideline-based best medical
therapy. Patients commence trial drug at low dose, increment to full dose
over 2–4 weeks, continuing on full dose for a year. We follow-up
participants to one year for symptoms, tablet compliance, safety, recurrent
vascular events, cognition and functional outcomes, Trails B and brain MRI.
LACI-2 is registered ISRCTN 14911850, EudraCT 2016–002277-35. Trial outcome: Primary outcome is feasibility of recruitment and
compliance; secondary outcomes include safety (cerebral or systemic
bleeding, falls, death), efficacy (recurrent cerebral and cardiac vascular
events, cognition on TICS, Trails B) and tolerability. Summary LACI-2 will determine feasibility, tolerability and provide outcome rates to
power a large phase 3 trial to prevent progression of cerebral small vessel
disease.
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Affiliation(s)
| | - Philip M W Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, The University of Nottingham, Nottingham, UK
| | | | - Anna Heye
- The University of Edinburgh, Edinburgh, UK
| | - Nikola Sprigg
- Stroke Trials Unit, Division of Clinical Neuroscience, The University of Nottingham, Nottingham, UK
| | | | | | | | - Vera Cvoro
- The University of Edinburgh, Edinburgh, UK
| | | | - Ahamad Hassan
- University College London Institute of Neurology, London, UK
| | | | - Alan Montgomery
- Stroke Trials Unit, Division of Clinical Neuroscience, The University of Nottingham, Nottingham, UK
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8
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Senda J, Ito K, Kotake T, Kanamori M, Kishimoto H, Kadono I, Nakagawa-Senda H, Wakai K, Katsuno M, Nishida Y, Ishiguro N, Sobue G. Cilostazol use is associated with FIM cognitive improvement during convalescent rehabilitation in patients with ischemic stroke: a retrospective study. NAGOYA JOURNAL OF MEDICAL SCIENCE 2020; 81:359-373. [PMID: 31579328 PMCID: PMC6728194 DOI: 10.18999/nagjms.81.3.359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cilostazol is a phosphodiesterase III-inhibiting antiplatelet agent that is often used to prevent stroke and peripheral artery disease, and its administration has shown significant improvements for cognitive impairment. We investigate the potential of cilostazol for reducing or restoring cognitive decline during convalescent rehabilitation in patients with non-cardioembolic ischemic stroke. The study sample included 371 consecutive patients with lacunar (n = 44) and atherothrombosis (n = 327) subtypes of non-cardioembolic ischemic stroke (224 men and 147 women; mean age, 72.9 ± 8.1 years) who were required for inpatient convalescent rehabilitation. Their medical records were retrospectively surveyed to identify those who had received cilostazol (n = 101). Patients were grouped based on cilostazol condition, and Functional Independence Measure (FIM) scores (total and motor or cognitive subtest scores) were assessed both at admission and discharge. The gain and efficiency in FIM cognitive scores from admission to discharge were significantly higher in patients who received cilostazol than those who did not (p = 0.047 and p = 0.035, respectively); we found no significant differences in other clinical factors or scores. Multiple linear regression analysis confirmed that cilostazol was a significant factor in FIM cognitive scores at discharge (β = 0.041, B = 0.682, p = 0.045); the two tested dosages were not significantly different (100 mg/day, n = 43; 200 mg/day, n = 58). Cilostazol can potentially improve cognitive function during convalescent rehabilitation of patients with non-cardioembolic ischemic stroke, although another research must be needed to confirm this potential.
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Affiliation(s)
- Joe Senda
- Department of Neurology and Rehabilitation, Komaki City Hospital, Komaki, Japan.,Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Division of Rehabilitation, Kami-iida Rehabilitation Hospital, Nagoya, Japan
| | - Keiichi Ito
- Division of Rehabilitation, Kami-iida Rehabilitation Hospital, Nagoya, Japan
| | - Tomomitsu Kotake
- Division of Rehabilitation, Kami-iida Rehabilitation Hospital, Nagoya, Japan
| | - Masahiko Kanamori
- Division of Rehabilitation, Kami-iida Rehabilitation Hospital, Nagoya, Japan
| | - Hideo Kishimoto
- Division of Rehabilitation, Kami-iida Rehabilitation Hospital, Nagoya, Japan
| | - Izumi Kadono
- Division of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Hiroko Nakagawa-Senda
- Department of Public Health, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kenji Wakai
- Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihiro Nishida
- Division of Rehabilitation, Nagoya University Hospital, Nagoya, Japan.,Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Division of Rehabilitation, Nagoya University Hospital, Nagoya, Japan.,Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Gen Sobue
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Research Division of Dementia and Neurodegenerative Disease, Nagoya University Graduate School of Medicine, Nagoya, Japan
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9
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Das AS, Regenhardt RW, Feske SK, Gurol ME. Treatment Approaches to Lacunar Stroke. J Stroke Cerebrovasc Dis 2019; 28:2055-2078. [PMID: 31151838 PMCID: PMC7456600 DOI: 10.1016/j.jstrokecerebrovasdis.2019.05.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/15/2019] [Accepted: 05/02/2019] [Indexed: 12/12/2022] Open
Abstract
Lacunar strokes are appropriately named for their ability to cavitate and form ponds or "little lakes" (Latin: lacune -ae meaning pond or pit is a diminutive form of lacus meaning lake). They account for a substantial proportion of both symptomatic and asymptomatic ischemic strokes. In recent years, there have been several advances in the management of large vessel occlusions. New therapies such as non-vitamin K antagonist oral anticoagulants and left atrial appendage closure have recently been developed to improve stroke prevention in atrial fibrillation; however, the treatment of small vessel disease-related strokes lags frustratingly behind. Since Fisher characterized the lacunar syndromes and associated infarcts in the late 1960s, there have been no therapies specifically targeting lacunar stroke. Unfortunately, many therapeutic agents used for the treatment of ischemic stroke in general offer only a modest benefit in reducing recurrent stroke while adding to the risk of intracerebral hemorrhage and systemic bleeding. Escalation of antithrombotic treatments beyond standard single antiplatelet agents has not been effective in long-term lacunar stroke prevention efforts, unequivocally increasing intracerebral hemorrhage risk without providing a significant benefit. In this review, we critically review the available treatments for lacunar stroke based on evidence from clinical trials. For several of the major drugs, we summarize the adverse effects in the context of this unique patient population. We also discuss the role of neuroprotective therapies and neural repair strategies as they may relate to recovery from lacunar stroke.
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Affiliation(s)
- Alvin S Das
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Steven K Feske
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mahmut Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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10
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Xiang Q, Pang X, Liu Z, Yang G, Tao W, Pei Q, Cui Y. Progress in the development of antiplatelet agents: Focus on the targeted molecular pathway from bench to clinic. Pharmacol Ther 2019; 203:107393. [PMID: 31356909 DOI: 10.1016/j.pharmthera.2019.107393] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 07/10/2019] [Indexed: 12/22/2022]
Abstract
Antiplatelet drugs serve as a first-line antithrombotic therapy for the management of acute ischemic events and the prevention of secondary complications in vascular diseases. Numerous antiplatelet therapies have been developed; however, currently available agents are still associated with inadequate efficacy, risk of bleeding, and variability in individual response. Understanding the mechanisms of platelet involvement in thrombosis and the clinical development process of antiplatelet agents is critical for the discovery of novel agents. The functions of platelets in thrombosis are regulated by two major mechanisms: the interaction between surface receptors and their ligands, and the downstream intracellular signaling pathways. Recently, most of the progress made in antiplatelet drug development has been achieved with P2Y receptor antagonists. Additionally, the usage of GP IIb/IIIa receptor antagonists has decreased, because it is associated with a higher risk of bleeding and thrombocytopenia. Agents targeting other platelet surface receptors such as PARs, TP receptor, EP3 receptor, GPIb-IX-V receptor, P-selectin, as well as intracellular signaling factors, such as PI3Kβ, have been evaluated in an attempt to develop the next generation of antiplatelet drugs, reduce or eliminate interpatient variability of drug efficacy and significantly lower the risk of drug-induced bleeding. The aim of this review is to describe the pathways of platelet activation in thrombosis, and summarize the development process of antiplatelet agents, as well as the preclinical and clinical evaluations performed on these agents.
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Affiliation(s)
- Qian Xiang
- Department of Pharmacy, Peking University First Hospital, No. 6, Da Hong Luo Chang Street, Xicheng District, Beijing 100034, China
| | - Xiaocong Pang
- Department of Pharmacy, Peking University First Hospital, No. 6, Da Hong Luo Chang Street, Xicheng District, Beijing 100034, China
| | - Zhenming Liu
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Guoping Yang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Research Center of Drug Clinical Evaluation of Central South University, 138 TongZiPo Road, Changsha, Hunan 410013, China
| | - Weikang Tao
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Research Center of Drug Clinical Evaluation of Central South University, 138 TongZiPo Road, Changsha, Hunan 410013, China
| | - Qi Pei
- Shanghai Hengrui Pharmaceuticals Co., 279 Wenjing Road, Shanghai, China
| | - Yimin Cui
- Department of Pharmacy, Peking University First Hospital, No. 6, Da Hong Luo Chang Street, Xicheng District, Beijing 100034, China.
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Toyoda K, Uchiyama S, Yamaguchi T, Easton JD, Kimura K, Hoshino H, Sakai N, Okada Y, Tanaka K, Origasa H, Naritomi H, Houkin K, Yamaguchi K, Isobe M, Minematsu K, Goto S, Isomura T, Matsumoto M, Terayama Y, Tomimoto H, Tominaga T, Yasuda S, Kumagai N. Dual antiplatelet therapy using cilostazol for secondary prevention in patients with high-risk ischaemic stroke in Japan: a multicentre, open-label, randomised controlled trial. Lancet Neurol 2019; 18:539-548. [DOI: 10.1016/s1474-4422(19)30148-6] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 03/18/2019] [Accepted: 03/21/2019] [Indexed: 11/16/2022]
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12
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Yasmeen S, Kaur S, Mirza AH, Brodin B, Pociot F, Kruuse C. miRNA-27a-3p and miRNA-222-3p as Novel Modulators of Phosphodiesterase 3a (PDE3A) in Cerebral Microvascular Endothelial Cells. Mol Neurobiol 2019; 56:5304-5314. [PMID: 30603956 DOI: 10.1007/s12035-018-1446-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 12/03/2018] [Indexed: 12/19/2022]
Abstract
Endothelial dysfunction is a key element in cerebral small vessel disease (CSVD), which may cause stroke and cognitive decline. Cyclic nucleotide signaling modulates endothelial function. The cyclic adenosine monophosphate-degrading enzyme phosphodiesterase 3 (PDE3) is an important treatment target which may be modulated by microRNAs (miRNAs) important for regulating gene expression. We aimed to identify PDE3-targeting miRNAs to highlight potential therapeutic targets for endothelial dysfunction and CSVD. PDE3-targeting miRNAs were identified by in silico analysis (TargetScan, miRWalk, miRanda, and RNA22). The identified miRNAs were ranked on the basis of TargetScan context scores and their expression (log2 read counts) in a human brain endothelial cell line (hCMEC/D3) described recently. miRNAs were subjected to co-expression meta-analysis (CoMeTa) to create miRNA clusters. The pathways targeted by the miRNAs were assigned functional annotations via the KEGG pathway and COOL. hCMEC/D3 cells were transfected with miRNA mimics miR-27a-3p and miR-222-3p, and the effect on PDE3A protein expression was analyzed by Western blotting. Only PDE3A is expressed in hCMEC/D3 cells. The in silico prediction identified 67 PDE3A-related miRNAs, of which 49 were expressed in hCMEC/D3 cells. Further analysis of the top two miRNA clusters (miR-221/miR-222 and miR-27a/miR-27b/miR-128) indicated a potential link to pathways relevant to cerebral and vascular integrity and repair. hCMEC/D3 cells transfected with miR-27a-3p and miR-222-3p mimics had reduced relative expression of PDE3A protein. PDE3A-related miRNAs miR-221/miR-222 and miR-27a/miR-27b/miR-128 are potentially linked to pathways essential for immune regulation as well as cerebral and vascular integrity/function. Furthermore, relative PDE3A protein expression was reduced by miR27a-3p and miR-222-3p.
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Affiliation(s)
- S Yasmeen
- Stroke Unit and Neurovascular Research Unit, Department of Neurology, Herlev and Gentofte Hospital, Herlev ringvej 75, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - S Kaur
- Pediatric Department, Herlev University Hospital, Herlev ringvej 75, Herlev, Denmark.,Steno Diabetes Center Copenhagen, Niels Steensens vej 2-4, 2820, Gentofte, Denmark
| | - A H Mirza
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Pediatric Department, Herlev University Hospital, Herlev ringvej 75, Herlev, Denmark
| | - B Brodin
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,CNS Drug Delivery and Barrier Modelling, University of Copenhagen, Nørre alle 67, Copenhagen, Denmark
| | - F Pociot
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Pediatric Department, Herlev University Hospital, Herlev ringvej 75, Herlev, Denmark.,Steno Diabetes Center Copenhagen, Niels Steensens vej 2-4, 2820, Gentofte, Denmark
| | - C Kruuse
- Stroke Unit and Neurovascular Research Unit, Department of Neurology, Herlev and Gentofte Hospital, Herlev ringvej 75, Herlev, Denmark. .,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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13
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Nomura S, Taniura T, Shouzu A, Omoto S, Suzuki M, Okuda Y, Ito T. Effects of sarpogrelate, eicosapentaenoic acid and pitavastatin on arterioslcerosis obliterans-related biomarkers in patients with type 2 diabetes (SAREPITASO study). Vasc Health Risk Manag 2018; 14:225-232. [PMID: 30271161 PMCID: PMC6151091 DOI: 10.2147/vhrm.s171143] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The aim was to evaluate the significance of arteriosclerosis obliterans-related biomarkers in patients with type 2 diabetes mellitus (T2DM), and to compare the effects of sarpogrelate, eicosapentaenoic acid (EPA) and pitavastatin on these markers. PATIENTS AND METHODS Seventy-two arteriosclerosis obliterans patients with T2DM were classified into two groups, pitavastatin with either sarpogrelate (PS) or EPA (PE). We observed no differences in all biomarkers between the PS and PE groups before treatments. RESULTS The levels of body mass index, hemoglobin A1c, soluble E-selectin, soluble vascular cell adhesion molecule 1, plasminogen activator inhibitor-1 and platelet-derived microparticle in the PE group decreased significantly after treatment. The ankle branchial pressure index and adiponectin levels significantly increased in the PE group after treatment compared with the PS group. CONCLUSION These results suggest that combination therapy using pitavastatin and EPA possesses an antiatherosclerotic effect and may be beneficial for prevention of vascular complications in patients with T2DM.
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Affiliation(s)
- Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, Hirakata,
| | | | - Akira Shouzu
- Division of Internal Medicine, Saiseikai Izuo Hospital, Osaka
| | - Seitaro Omoto
- Division of Internal Medicine, Korigaoka Yukeikai Hospital, Hirakata
| | | | - Yoshinori Okuda
- Division of Internal Medicine, Meisei Memorial Hospital, Osaka, Japan
| | - Tomoki Ito
- First Department of Internal Medicine, Kansai Medical University, Hirakata,
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14
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Kim JS, Bang OY. Medical Treatment of Intracranial Atherosclerosis: An Update. J Stroke 2017; 19:261-270. [PMID: 29037012 PMCID: PMC5647642 DOI: 10.5853/jos.2017.01830] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/07/2017] [Accepted: 09/14/2017] [Indexed: 12/13/2022] Open
Abstract
For patients with symptomatic intracranial atherosclerosis (ICAS), antithrombotic agents are the mainstay of therapy. Anticoagulation (warfarin) is not widely used since it is not more effective than aspirin and carries a high risk of bleeding. New oral anticoagulants are showing promise, but their use has not been investigated in appropriate clinical trials. Since the recurrent stroke risk is high with aspirin monotherapy, dual antiplatelets are considered in the early stage of symptomatic ICAS. Based on the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) and Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) results, aspirin plus clopidogrel has been recommended. However, this combination was not superior to aspirin monotherapy in patients with ICAS in the CHANCE substudy. Progression of ICAS is common, and it is associated with recurrent strokes. In the Trial of Cilostazol in Symptomatic Intracranial Arterial Stenosis (TOSS) study, aspirin plus cilostazol was more effective than aspirin monotherapy in preventing progression. The TOSS II trial showed that the overall change in stenosis was better with aspirin plus cilostazol than with aspirin plus clopidogrel. Aside from antithrombotic therapy, risk factor management is critical for secondary prevention, and high blood pressure is clearly linked to recurrent stroke. However, blood pressure may have to be cautiously managed in the early stage of stroke. Considering that ICAS is the major cause of stroke worldwide, further investigations are needed to establish optimal management strategies for patients with ICAS.
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Affiliation(s)
- Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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15
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Blair GW, Appleton JP, Law ZK, Doubal F, Flaherty K, Dooley R, Shuler K, Richardson C, Hamilton I, Shi Y, Stringer M, Boyd J, Thrippleton MJ, Sprigg N, Bath PM, Wardlaw JM. Preventing cognitive decline and dementia from cerebral small vessel disease: The LACI-1 Trial. Protocol and statistical analysis plan of a phase IIa dose escalation trial testing tolerability, safety and effect on intermediary endpoints of isosorbide mononitrate and cilostazol, separately and in combination. Int J Stroke 2017; 13:530-538. [DOI: 10.1177/1747493017731947] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Rationale The pathophysiology of most lacunar stroke, a form of small vessel disease, is thought to differ from large artery atherothrombo- or cardio-embolic stroke. Licensed drugs, isosorbide mononitrate and cilostazol, have promising mechanisms of action to support their testing to prevent stroke recurrence, cognitive impairment, or radiological progression after lacunar stroke. Aim LACI-1 will assess the tolerability, safety, and efficacy, by dose, of isosorbide mononitrate and cilostazol, alone and in combination, in patients with ischemic lacunar stroke. Sample size A sample of 60 provides 80+% power (significance 0.05) to detect a difference of 35% (90% versus 55%) between those reaching target dose on one versus both drugs. Methods and design LACI-1 is a phase IIa partial factorial, dose-escalation, prospective, randomized, open label, blinded endpoint trial. Participants are randomized to isosorbide mononitrate and/or cilostazol for 11 weeks with dose escalation to target as tolerated in two centers (Edinburgh, Nottingham). At three visits, tolerability, safety, blood pressure, pulse wave velocity, and platelet function are assessed, plus magnetic resonance imaging to assess cerebrovascular reactivity in a subgroup. Study outcomes Primary: proportion of patients completing study achieving target maximum dose. Secondary symptoms whilst taking medications; safety (hemorrhage, recurrent vascular events, falls); blood pressure, platelet function, arterial stiffness, and cerebrovascular reactivity. Discussion This study will inform the design of a larger phase III trial of isosorbide mononitrate and cilostazol in lacunar stroke, whilst providing data on the drugs’ effects on vascular and platelet function. Trial registration ISRCTN (ISRCTN12580546) and EudraCT (2015-001953-33).
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Affiliation(s)
- Gordon W Blair
- Centre for Clinical Brain Sciences, University
of Edinburgh, Edinburgh, UK
- Edinburgh Dementia Research Centre in the UK
Dementia Research Institute, University of Edinburgh, Edinburgh, UK
- Fondation Leducq Network for the Study of
Perivascular Spaces in Small Vessel Disease, University of Edinburgh, Edinburgh, UK
| | - Jason P Appleton
- Stroke Trials Unit, Division of Clinical
Neuroscience,
University
of Nottingham, Nottingham, UK
| | - Zhe Kang Law
- Stroke Trials Unit, Division of Clinical
Neuroscience,
University
of Nottingham, Nottingham, UK
- Department of Medicine, National University of
Malaysia, Kuala Lumpur, Malaysia
| | - Fergus Doubal
- Centre for Clinical Brain Sciences, University
of Edinburgh, Edinburgh, UK
- Edinburgh Dementia Research Centre in the UK
Dementia Research Institute, University of Edinburgh, Edinburgh, UK
- Fondation Leducq Network for the Study of
Perivascular Spaces in Small Vessel Disease, University of Edinburgh, Edinburgh, UK
| | - Katie Flaherty
- Stroke Trials Unit, Division of Clinical
Neuroscience,
University
of Nottingham, Nottingham, UK
| | - Richard Dooley
- Stroke Trials Unit, Division of Clinical
Neuroscience,
University
of Nottingham, Nottingham, UK
| | - Kirsten Shuler
- Centre for Clinical Brain Sciences, University
of Edinburgh, Edinburgh, UK
- Edinburgh Dementia Research Centre in the UK
Dementia Research Institute, University of Edinburgh, Edinburgh, UK
- Fondation Leducq Network for the Study of
Perivascular Spaces in Small Vessel Disease, University of Edinburgh, Edinburgh, UK
| | - Carla Richardson
- Stroke Trials Unit, Division of Clinical
Neuroscience,
University
of Nottingham, Nottingham, UK
| | - Iona Hamilton
- Centre for Clinical Brain Sciences, University
of Edinburgh, Edinburgh, UK
- Edinburgh Dementia Research Centre in the UK
Dementia Research Institute, University of Edinburgh, Edinburgh, UK
- Fondation Leducq Network for the Study of
Perivascular Spaces in Small Vessel Disease, University of Edinburgh, Edinburgh, UK
| | - Yulu Shi
- Centre for Clinical Brain Sciences, University
of Edinburgh, Edinburgh, UK
- Edinburgh Dementia Research Centre in the UK
Dementia Research Institute, University of Edinburgh, Edinburgh, UK
- Fondation Leducq Network for the Study of
Perivascular Spaces in Small Vessel Disease, University of Edinburgh, Edinburgh, UK
| | - Michael Stringer
- Centre for Clinical Brain Sciences, University
of Edinburgh, Edinburgh, UK
- Edinburgh Dementia Research Centre in the UK
Dementia Research Institute, University of Edinburgh, Edinburgh, UK
- Fondation Leducq Network for the Study of
Perivascular Spaces in Small Vessel Disease, University of Edinburgh, Edinburgh, UK
| | - Julia Boyd
- Edinburgh Clinical Trial’s Unit, Western
General Hospital, Edinburgh, UK
| | - Michael J Thrippleton
- Centre for Clinical Brain Sciences, University
of Edinburgh, Edinburgh, UK
- Edinburgh Dementia Research Centre in the UK
Dementia Research Institute, University of Edinburgh, Edinburgh, UK
- Fondation Leducq Network for the Study of
Perivascular Spaces in Small Vessel Disease, University of Edinburgh, Edinburgh, UK
| | - Nikola Sprigg
- Stroke Trials Unit, Division of Clinical
Neuroscience,
University
of Nottingham, Nottingham, UK
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical
Neuroscience,
University
of Nottingham, Nottingham, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University
of Edinburgh, Edinburgh, UK
- Edinburgh Dementia Research Centre in the UK
Dementia Research Institute, University of Edinburgh, Edinburgh, UK
- Fondation Leducq Network for the Study of
Perivascular Spaces in Small Vessel Disease, University of Edinburgh, Edinburgh, UK
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16
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Hwang DJ, Shin JY, Yu HG. Oral Administration of Cilostazol Increases Ocular Blood Flow in Patients with Diabetic Retinopathy. KOREAN JOURNAL OF OPHTHALMOLOGY 2017; 31:123-131. [PMID: 28367040 PMCID: PMC5368085 DOI: 10.3341/kjo.2017.31.2.123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 02/17/2016] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To investigate the effect of cilostazol on ocular hemodynamics and to determine whether the administration of cilostazol increases the ocular blood flow in patients with diabetic retinopathy. METHODS This prospective observational study investigated the effect of orally administered cilostazol on diabetic retinopathy. Before and after administration for 1 week, pulsatile ocular blood flow (POBF) and retrobulbar hemodynamics were measured using a POBF analyzer and transcranial Doppler imaging, respectively. Visual acuity, intraocular pressure, and blood pressure were also evaluated before and after treatment. RESULTS Twenty-five eyes of 25 patients were included in this study. POBF increased significantly (16.8 ± 4.6 µL/sec vs. 19.6 ± 6.2 µL/sec, p < 0.001) after administration of cilostazol, while no significant change was identified in visual acuity, intraocular pressure, and blood pressure. Mean flow velocity in the ophthalmic artery as measured with transcranial Doppler imaging also increased significantly after medication (23.5 ± 5.6 cm/sec vs. 26.0 ± 6.9 cm/sec, p = 0.001). The change in POBF directly correlated with the change in mean flow velocity (r = 0.419, p = 0.007). CONCLUSIONS Cilostazol was effective in increasing ocular blood flow in patients with diabetic retinopathy, possibly by modulating retrobulbar circulation.
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Affiliation(s)
- Duck Jin Hwang
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.; HanGil Eye Hospital, Incheon, Korea
| | - Joo Young Shin
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeong Gon Yu
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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17
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Munshi A, Das S. Genetic Understanding of Stroke Treatment: Potential Role for Phosphodiesterase Inhibitors. ADVANCES IN NEUROBIOLOGY 2017; 17:445-461. [PMID: 28956342 DOI: 10.1007/978-3-319-58811-7_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Phosphodiesterase (PDE) gene family is a large family having at least 21 genes and multiple versions (isoforms) of the phosphodiesterase enzymes. These enzymes catalyze the inactivation of intracellular mediators of signal transduction such as cAMP and cGMP and therefore, play a pivotal role in various cellular functions. PDE inhibitors (PDEI) are drugs that block one or more of the five subtypes of the PDE family and thereby prevent inactivation of the intracellular cAMP and cGMP by the respective PDE-subtypes. The first clinical use of PDEI was reported almost three decades ago. Studies later found the ability of these compounds to increase the levels of ubiquitous secondary messenger molecules that can cause changes in vascular tone, cardiac function and other cellular events and thus these findings paved the way for their use in various medical emergencies. PDEs are found to be distributed in many tissues including brain. Therefore, new therapeutic agents in the form of PDEI are being explored in neurodegenerative diseases including stroke. Although studies have revealed their use in cerebral infarction prevention, their full-fledged application in times of neurological emergency or stroke in specific has been very limited so far. Nevertheless, recent investigations suggest PDE4 and PDE5 inhibitors to play a vital role in mitigating stroke symptoms by modulating signaling mechanisms in PDE pathway. Further, extensive research in terms of their pharmacological properties like dosing, drug specific activities, use of simultaneous medications, ancillary properties of these compounds and studies on adverse drug reactions needs to be carried out to set them as standard drugs of use in stroke.
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Affiliation(s)
- Anjana Munshi
- Centre for Human Genetics and Molecular Medicine, School of Health Sciences, Central University of Punjab, Bathinda, Punjab, India.
| | - Satrupa Das
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet, Hyderabad, 500016, India
- Dr. NTR University of Health Sciences, Vijayawada, Andhra Pradesh, India
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18
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Role of Cilostazol Therapy in Hemodialysis Patients with Asymptomatic Peripheral Arterial Disease: A Retrospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8236903. [PMID: 27747241 PMCID: PMC5055930 DOI: 10.1155/2016/8236903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/11/2016] [Indexed: 12/29/2022]
Abstract
Background. Peripheral arterial disease (PAD) and its relevant complications are more common in hemodialysis (HD) patients, while the evidence regarding antiplatelet therapy in CKD patients is scarce. We retrospectively analyzed the efficacy of cilostazol on outcomes in HD patients with asymptomatic PAD (aPAD). Methods. This cohort study enrolled 217 HD patients (median follow-up time: 5.75 years). Associations between cilostazol use and the outcomes were evaluated by time-dependent Cox regression analysis. Results. During follow-up, 39.5% (47/119) patients used cilostazol for aPAD and 31.8% (69/217) patients died. Cilostazol users had significantly lower CVD and all-cause mortalities (adjusted HR [95% CI]: 0.11 [0.03, 0.51] and 0.2 [0.08, 0.52]) than nonusers. Both death risks were nonsignificantly higher in cilostazol users than in HD patients without aPAD. The unadjusted and adjusted HR [95% CI] of CVD death risk were 0.4 [0.07, 2.12] and 0.14 [0.02, 0.8] for patients with aPAD during follow-up and were 0.74 [0.16, 3.36] and 0.19 [0.04, 0.93] for those with aPAD at initial. Conclusions. In HD patients with aPAD, lower CVD and all-cause mortality rates were observed in low-dose cilostazol user. Further evidences from large-scale prospective study and randomization trial are desired to confirm the effect of cilostazol.
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19
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Treatment with cilostazol improves clinical outcome after endovascular therapy in hemodialysis patients with peripheral artery disease. J Cardiol 2016; 67:199-204. [DOI: 10.1016/j.jjcc.2015.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 04/17/2015] [Accepted: 05/01/2015] [Indexed: 11/24/2022]
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20
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Biondi-Zoccai G, Frati G, Coscioni E, Giordano A. Commentary: Cilostazol and Carotid Stenting: A Merry Marriage? J Endovasc Ther 2016; 23:196-8. [PMID: 26763261 DOI: 10.1177/1526602815619405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy Eleonora Lorillard Spencer Cenci Foundation, Rome, Italy
| | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
| | - Enrico Coscioni
- Division of Cardiac Surgery, San Giovanni di Dio e Ruggi D'Aragona Hospital, Salerno, Italy
| | - Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Presidio Ospedaliero Pineta Grande, Castel Volturno, Italy Unità Operativa di Emodinamica, Casa di Salute Santa Lucia, San Giuseppe Vesuviano, Italy
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21
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Koh JS, Yi CO, Heo RW, Ahn JW, Park JR, Lee JE, Kim JH, Hwang JY, Roh GS. Protective effect of cilostazol against doxorubicin-induced cardiomyopathy in mice. Free Radic Biol Med 2015; 89:54-61. [PMID: 26191652 DOI: 10.1016/j.freeradbiomed.2015.07.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 07/10/2015] [Accepted: 07/15/2015] [Indexed: 10/23/2022]
Abstract
Doxorubicin (Dox) is an effective anti-cancer drug, but its use is limited because of its adverse effect of inducing irreversible dilated cardiomyopathy. Cilostazol (Cilo), a potent phosphodiesterase III inhibitor, has been reported to have an anti-inflammatory effect. Here, we investigated whether Cilo has a protective effect against Dox-induced cardiomyopathy (DIC). Mice were randomly divided into four groups: saline control, Dox (15 mg/kg), Dox (15 mg/kg) plus Cilo (50mg/kg), and Cilo (50mg/kg). The results showed that the coadministration of Dox and Cilo significantly enhanced left-ventricular systolic function compared with Dox alone. In addition, Cilo treatment significantly reduced Dox-induced perivascular fibrosis, collagen concentration, and connective growth factor expression in the heart. Also, Cilo administration markedly reduced Dox-induced levels of serum B-type natriuretic peptide, dysferlin, high-mobility group protein B1, Toll-like receptor 4, nuclear factor-κB p65, and cyclooxygenase-2. Furthermore, Cilo treatment significantly reduced Dox-induced oxidative stress by lowering the translocation of Nrf2 into the nucleus and the expression of NQO1, heme oxygenase 1, and superoxide dismutase-1. Our results suggest that Cilo may be a potential antifibrotic, antioxidative, and anti-inflammatory drug for DIC.
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Affiliation(s)
- Jin Sin Koh
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju 660-751, Republic of Korea
| | - Chin-ok Yi
- Department of Anatomy and Convergence Medical Science, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 660-751, Republic of Korea
| | - Rok Won Heo
- Department of Anatomy and Convergence Medical Science, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 660-751, Republic of Korea
| | - Jong-Wha Ahn
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju 660-751, Republic of Korea
| | - Jeong Rang Park
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju 660-751, Republic of Korea
| | - Jung Eun Lee
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju 660-751, Republic of Korea
| | - Jung-Hwan Kim
- Department of Pharmacology, Institute of Health Sciences, Gyeongsang National University School of Medicine,Jinju 660-751, Republic of Korea
| | - Jin-Yong Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju 660-751, Republic of Korea.
| | - Gu Seob Roh
- Department of Anatomy and Convergence Medical Science, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 660-751, Republic of Korea.
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22
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Toyoda K, Koga M, Hayakawa M, Yamagami H. Acute Reperfusion Therapy and Stroke Care in Asia After Successful Endovascular Trials. Stroke 2015; 46:1474-81. [DOI: 10.1161/strokeaha.115.008781] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 03/25/2015] [Indexed: 01/13/2023]
Affiliation(s)
- Kazunori Toyoda
- From the Department of Cerebrovascular Medicine (K.T., M.H.), Division of Stroke Care Unit (M.K.), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masatoshi Koga
- From the Department of Cerebrovascular Medicine (K.T., M.H.), Division of Stroke Care Unit (M.K.), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Mikito Hayakawa
- From the Department of Cerebrovascular Medicine (K.T., M.H.), Division of Stroke Care Unit (M.K.), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroshi Yamagami
- From the Department of Cerebrovascular Medicine (K.T., M.H.), Division of Stroke Care Unit (M.K.), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
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23
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Ara N, Iijima K, Maejima R, Kondo Y, Kusaka G, Hatta W, Uno K, Asano N, Koike T, Imatani A, Shimosegawa T. Prospective analysis of risk for bleeding after endoscopic biopsy without cessation of antithrombotics in Japan. Dig Endosc 2015; 27:458-464. [PMID: 25425518 DOI: 10.1111/den.12407] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 11/20/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM In Japan, after the revision of the gastrointestinal endoscopic guidelines for patients taking antithrombotics, endoscopic biopsies were permitted while continuing antithrombotic treatment. However, the risk of bleeding after the biopsy with or without cessation of antithrombotics has not been fully evaluated because bleeding events are very rare. The aim of this prospective study was to evaluate the risk for bleeding after upper gastrointestinal biopsy without cessation of antithrombotics. METHODS Consecutive patients who underwent upper gastrointestinal endoscopic biopsy from December 2011 to March 2014 were enrolled in this study. Antithrombotic medication and its cessation status was checked at enrollment. To confirm bleeding events associated with biopsy, medical examination at the hospital or direct confirmation by telephone was done within 1 month after the biopsy. RESULTS Among the 3758 patients who underwent endoscopic biopsies, 394 patients (10.5%) were medicated with antithrombotics, and 286 of them (72.6% of the total antithrombotics users) did not undergo cessation. Bleeding after the biopsy occurred in six cases (0.15%, 95% CI; 0.09%∼0.22%), but there was only one case that had continued taking antithrombotics. The incidence of bleeding after biopsy was not significantly higher in the patients who had continued taking antithrombotics compared with the others (0.35% vs 0.14%, P = 0.38). CONCLUSION This prospective study showed that continuation of antithrombotics did not increase the bleeding risk after upper gastrointestinal endoscopic biopsy.
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Affiliation(s)
- Nobuyuki Ara
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Katsunori Iijima
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Ryuhei Maejima
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Yutaka Kondo
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Gen Kusaka
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Kaname Uno
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Naoki Asano
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Akira Imatani
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Tooru Shimosegawa
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
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Katsanos K, Spiliopoulos S, Saha P, Diamantopoulos A, Karunanithy N, Krokidis M, Modarai B, Karnabatidis D. Comparative Efficacy and Safety of Different Antiplatelet Agents for Prevention of Major Cardiovascular Events and Leg Amputations in Patients with Peripheral Arterial Disease: A Systematic Review and Network Meta-Analysis. PLoS One 2015; 10:e0135692. [PMID: 26274912 PMCID: PMC4537264 DOI: 10.1371/journal.pone.0135692] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 07/25/2015] [Indexed: 02/05/2023] Open
Abstract
There is a lack of consensus regarding which type of antiplatelet agent should be used in patients with peripheral arterial disease (PAD) and little is known on the advantages and disadvantages of dual antiplatelet therapy. We conducted a systematic review and network meta-analysis of available randomized controlled trials (RCT) comparing different antiplatelet drugs (Aspirin, Ticlopidine, Clopidogrel, Ticagrelor, Cilostazol, Picotamide and Vorapaxar as monotherapies or in combination with aspirin) in PAD patients (PROSPERO public database; CRD42014010299).We collated evidence from previous relevant meta-analyses and searched online databases. Primary efficacy endpoints were: (1) the composite rate of major adverse cardiovascular events (MACE; including vascular deaths, non-fatal myocardial infarction and non-fatal stroke), and (2) the rate of major leg amputations. The primary safety endpoint was the rate of severe bleeding events. Bayesian models were employed for multiple treatment comparisons and risk-stratified hierarchies of comparative efficacy were produced to aid medical decision making. Number-Needed-to-Treat (NNT) and Number-Needed-to-Harm (NNH) are reported in case of significant results. We analyzed 49 RCTs comprising 34,518 patients with 88,358 person-years of follow-up with placebo as reference treatment. Aspirin, Cilostazol, Vorapaxar and Picotamide were ineffective in reducing MACE. A significant MACE reduction was noted with Ticagrelor plus aspirin (RR: 0.67; 95%CrI: 0.46-0.96, NNT = 66), Clopidogrel (RR: 0.72; 95%CrI: 0.58-0.91, NNT = 80), Ticlopidine (RR: 0.75; 95%CrI: 0.58-0.96, NNT = 87), and Clopidogrel plus aspirin (RR: 0.78; 95%CrI: 0.61-0.99, NNT = 98). Dual antiplatelet therapy with Clopidogrel plus aspirin significantly reduced major amputations following leg revascularization (RR: 0.68; 95%CrI: 0.46-0.99 compared to aspirin, NNT = 94). The risk of severe bleeding was significantly higher with Ticlopidine (RR: 5.03; 95%CrI: 1.23-39.6, NNH = 25), Vorapaxar (RR: 1.80; 95%CrI: 1.22-2.69, NNH = 130), and Clopidogrel plus aspirin (RR: 1.48; 95%CrI: 1.05-2.10, NNH = 215). Clopidogrel monotherapy showed the most favourable benefit-harm profile (79% cumulative rank probability best and 77% cumulative rank probability safest). In conclusion, Clopidogrel should be the indicated antiplatelet agent in PAD patients. Dual antiplatelet therapy with aspirin and Clopidogrel can reduce the rate of major leg amputations following revascularization, but carries a slightly higher risk of severe bleeding.
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Affiliation(s)
- Konstantinos Katsanos
- Department of Interventional Radiology, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, King's Health Partners, London, United Kingdom
- Department of Interventional Radiology, Patras University Hospital, School of Medicine, Rion, Greece
- * E-mail:
| | - Stavros Spiliopoulos
- Department of Interventional Radiology, Patras University Hospital, School of Medicine, Rion, Greece
| | - Prakash Saha
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at King’s Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Athanasios Diamantopoulos
- Department of Interventional Radiology, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, King's Health Partners, London, United Kingdom
| | - Narayan Karunanithy
- Department of Interventional Radiology, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, King's Health Partners, London, United Kingdom
| | - Miltiadis Krokidis
- Department of Interventional Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Bijan Modarai
- Academic Department of Surgery, Cardiovascular Division, Kings College London, BHF Centre of Research Excellence & NIHR Biomedical Research Centre at King’s Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Dimitris Karnabatidis
- Department of Interventional Radiology, Patras University Hospital, School of Medicine, Rion, Greece
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Meschia JF, Bushnell C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, Creager MA, Eckel RH, Elkind MSV, Fornage M, Goldstein LB, Greenberg SM, Horvath SE, Iadecola C, Jauch EC, Moore WS, Wilson JA. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:3754-832. [PMID: 25355838 PMCID: PMC5020564 DOI: 10.1161/str.0000000000000046] [Citation(s) in RCA: 973] [Impact Index Per Article: 97.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale.
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Jeng JS, Sun Y, Lee JT, Lin RT, Chen CH, Po HL, Lin HJ, Liu CH, Sun MH, Sun MC, Chern CM, Lien LM, Chiu HC, Hu HH, Chiou HY, Chen ST, Ma H, Hsu CY. 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. Int J Stroke 2014; 10:123-7. [PMID: 25394855 DOI: 10.1111/ijs.12384] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/15/2014] [Indexed: 12/23/2022]
Abstract
RATIONALE It is not uncommon for patients with ischemic stroke to have peripheral arterial disease (PAD). Patients with polyvascular diseases carry greater burden of atherosclerosis and higher risks of developing vascular events and death. More effective regimens, such as dual antiplatelet agents, may be more effective for controlling progression of atherosclerosis in secondary prevention. AIM This study aims to evaluate whether cilostazol plus aspirin is more efficacious than aspirin alone for preventing progression of atherosclerosis in patients with ischemic stroke or transient ischemic attack (TIA) who also have peripheral arterial disease. DESIGN The Safety and Efficacy of Cilostazol in Ischemic Stroke Patients with Peripheral Arterial Disease (SPAD) study is a randomized double-blinded placebo-controlled trial. Patients with previous ischemic stroke or TIA who had been taking aspirin (100 mg per day), aged 50 years or older, with PAD in the lower limbs based on ankle-brachial index (ABI) <1·0 will be randomized into the treatment group with cilostazol (200 mg/day) or the placebo group on 1:1 basis. STUDY OUTCOMES Patients will be evaluated at 1, 3, 6, 9 and 12 months after randomization. The primary endpoint is difference in change in ABI between groups. The secondary and tertiary endpoints are the difference between groups in change in carotid intima-media thickness (IMT) and incidence rate of major cardiovascular events, including recurrent stroke, myocardial infarction, unstable angina, other vascular events, and death; and the safety measures, including major bleeding events, hemorrhagic stroke and death of any cause. CONCLUSION The 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.
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Affiliation(s)
- Jiann-Shing Jeng
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
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Carotid Plaque Characteristics on Magnetic Resonance Plaque Imaging Following Long-term Cilostazol Therapy. J Stroke Cerebrovasc Dis 2014; 23:2425-30. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 05/20/2014] [Indexed: 11/20/2022] Open
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28
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Resnick KA, Gordon IL. Effects of Cilostazol on Arterial Wound Healing: A Retrospective Analysis. Ann Vasc Surg 2014; 28:1513-21. [DOI: 10.1016/j.avsg.2014.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 02/06/2014] [Accepted: 02/09/2014] [Indexed: 10/25/2022]
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Uchiyama S, Shinohara Y, Katayama Y, Yamaguchi T, Handa S, Matsuoka K, Ohashi Y, Tanahashi N, Yamamoto H, Genka C, Kitagawa Y, Kusuoka H, Nishimaru K, Tsushima M, Koretsune Y, Sawada T, Hamada C. Benefit of Cilostazol in Patients with High Risk of Bleeding: Subanalysis of Cilostazol Stroke Prevention Study 2. Cerebrovasc Dis 2014; 37:296-303. [DOI: 10.1159/000360811] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 02/24/2014] [Indexed: 11/19/2022] Open
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30
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Kalantzi KI, Tsoumani ME, Goudevenos IA, Tselepis AD. Pharmacodynamic properties of antiplatelet agents: current knowledge and future perspectives. Expert Rev Clin Pharmacol 2014; 5:319-36. [PMID: 22697594 DOI: 10.1586/ecp.12.19] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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31
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Fujimoto K, Fujishiro M, Kato M, Higuchi K, Iwakiri R, Sakamoto C, Uchiyama S, Kashiwagi A, Ogawa H, Murakami K, Mine T, Yoshino J, Kinoshita Y, Ichinose M, Matsui T. Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. Dig Endosc 2014; 26:1-14. [PMID: 24215155 DOI: 10.1111/den.12183] [Citation(s) in RCA: 304] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 09/02/2013] [Indexed: 12/13/2022]
Abstract
Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment have been produced by the Japan Gastroenterological Endoscopy Society in collaboration with the Japan Circulation Society, the Japanese Society of Neurology, the Japan Stroke Society, the Japanese Society on Thrombosis and Hemostasis and the Japan Diabetes Society. Previous guidelines from the Japan Gastroenterological Endoscopy Society have focused primarily on prevention of hemorrhage after gastroenterological endoscopy as a result of continuation ofantithrombotic therapy, without considering the associated risk of thrombosis. The new edition of the guidelines includes discussions of gastroenterological hemorrhage associated with continuation of antithrombotic therapy, as well as thromboembolism associated with withdrawal of antithrombotic therapy.
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Affiliation(s)
- Kazuma Fujimoto
- The Japan Gastroenterological Endoscopy Society, Tokyo, Japan
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32
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Lukasik M, Owecki MK. Efficacy of Antiplatelet Treatment in Stroke Prevention: Past, Present, and Future. Drug Dev Res 2013. [DOI: 10.1002/ddr.21100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Maria Lukasik
- Department of Neurology; Poznan University of Medical Sciences; Poznan; Poland
| | - Michal K. Owecki
- Department of Neurology; Poznan University of Medical Sciences; Poznan; Poland
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33
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Kitashoji A, Egashira Y, Mishiro K, Suzuki Y, Ito H, Tsuruma K, Shimazawa M, Hara H. Cilostazol ameliorates warfarin-induced hemorrhagic transformation after cerebral ischemia in mice. Stroke 2013; 44:2862-8. [PMID: 23881959 DOI: 10.1161/strokeaha.113.001183] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE Although long-term treatment with the oral anticoagulant warfarin is widely used to prevent cardioembolic ischemic stroke, it has been reported that warfarin can exacerbate hemorrhagic transformation (HT) after cerebral ischemia. We investigated whether cilostazol, a phosphodiesterase-III inhibitor, suppressed the warfarin-induced HT after cerebral ischemia in mice. METHODS Male ddY mice were treated with oral warfarin before 3-hour middle cerebral artery occlusion followed by 21-hour reperfusion to induce HT. The duration of warfarin pretreatment was determined by measurement of prothrombin time-international normalized ratio value. Cilostazol or vehicle was administered by intraperitoneal injection immediately after reperfusion. The infarct volume, brain swelling, and brain hemoglobin content were evaluated at 24 hours after middle cerebral artery occlusion. We also evaluated the survival rate of each treated group for 7 days after surgery. To investigate the mechanism underlying cilostazol's effects, the proteins involved in vascular endothelial integrity were investigated using Western blotting. RESULTS HT volume was exacerbated by warfarin treatment, and cilostazol (3 mg/kg, i.p.) suppressed this exacerbation (sham, mean±SD, 29.2±13.4 mg/dL; vehicle, 33.3±11.9 mg/dL; warfarin, 379.4±428.9 mg/dL; warfarin+cilostazol 1 mg/kg, 167.5±114.2 mg/dL; warfarin+cilostazol 3 mg/kg, 116.9±152.3 mg/dL). Furthermore, cilostazol improved survival rate and upregulated the expression of tight junction proteins and vascular endothelial cadherin. CONCLUSIONS Cilostazol reduced the warfarin-related risk of HT after ischemia by protecting the vascular endothelial cells. This result suggested that cilostazol administration in patients with acute ischemic stroke might reduce HT.
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Affiliation(s)
- Akira Kitashoji
- From the Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan (A.K., Y.E., K.M., Y.S., K.T., M.S., H.H.); and First Institute of New Drug Discovery, Otsuka Pharmaceutical Co Ltd, Tokushima, Japan (H.I.)
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Yanamoto H, Kataoka H, Nakajo Y, Iihara K. The Role of the Host Defense System in the Development of Cerebral Vasospasm: Analogies between Atherosclerosis and Subarachnoid Hemorrhage. Eur Neurol 2012; 68:329-43. [DOI: 10.1159/000341336] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 06/24/2012] [Indexed: 01/13/2023]
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Uchiyama S. [Results of the Cilostazol Stroke Prevention Study II (CSPS II): a randomized controlled trial for the comparison of cilostazol and aspirin in stroke patients]. Rinsho Shinkeigaku 2012; 50:832-4. [PMID: 21921460 DOI: 10.5692/clinicalneurol.50.832] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We compared the efficacy and safety of cilostazol and aspirin in 2,672 Japanese patients with non-cardioembolic ischemic stroke. The patients were randomized to be allocated either on cilostazol (200 mg/day) group or aspirin (81 mg/day) group, and were followed up for one to five years (average 29 months). The primary endpoint was any stroke, and safety endpoint was hemorrhagic stroke or hemorrhage requiring hospitalization. Annual incidence of stroke was significantly lower in the cilostazol group (2.76%) than in the aspirin group (3.71%) (relative risk reduction [RRR] 25.7%, p=0.0357) and annual incidence of hemorrhagic stroke or hemorrhage requiring hospitalization was 0.77% in the cilostazol group and 1.77% in the aspirin group (RRR 54.2%, p=0.0004). The sub-analyses between subtypes of ischemic stroke showed that annual incidence of hemorrhagic stroke was much lower in the cilostazol group (0.36%) than in the aspirin group (1.20%) among patients with lacunar stroke (p=0.003). The results suggest that cilostazol has a favorable risk-benefit profile alternative to aspirin for secondary stroke prevention in patients with non-cardioembolic ischemic stroke, particularly in patients with lacunar stroke, who are at high risk of hemorrhagic stroke.
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36
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Yagi H, Yamaguchi N, Shida Y, Hayakawa M, Matsumoto M, Sugimoto M, Wada H, Tsubaki K, Fujimura Y. Cilostazol down-regulates the height of mural platelet thrombi formed under a high-shear rate flow in the absence of ADAMTS13 activity. Eur J Pharmacol 2012; 691:151-5. [PMID: 22796451 DOI: 10.1016/j.ejphar.2012.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 06/24/2012] [Accepted: 07/02/2012] [Indexed: 10/28/2022]
Abstract
Cilostazol is an anti-platelet drug that reversibly inhibits phosphodiesterase III (PDE-III), which is ubiquitously expressed in platelets and various tissues. PDE-III converts cyclic adenosine monophosphate (cAMP) to 5'-AMP and up-regulates the intracellular concentration of cAMP, a potent inhibitor of platelet aggregation. Unlike other anti-platelet drugs, cilostazol is unique because patients receiving this drug do not have a significantly prolonged bleeding time, but the reasons for this difference are still unknown. In this study, we have examined how cilostazol inhibits platelet thrombus formation using anti-coagulated normal whole blood in which the platelets were labeled with a fluorescent dye in comparison with the anti-GPIIb/IIIa agent, tirofiban. We used an in vitro assay to examine mural platelet thrombus growth on a collagen surface under a high-shear rate flow in the absence of ADAMTS13 activity. These experimental conditions mimic the blood flow in patients with thrombotic thrombocytopenic purpura. Using this model, we clearly determined that cilostazol down-regulates the height of mural platelet thrombi formed on a collagen surface in a dose-dependent manner, without affecting the surface coverage. The concentration of cilostazol used in this study was relatively high (60-120 μM) compared to clinically relevant concentrations (1-3 μM), which may be due to the in vivo synergistic effects of PDE-III present in other tissues aside from platelets. Cilostazol does not affect the initial formation of platelet thrombi, but does inhibit the height of thrombi. These results showed a sharp contrast to tirofiban, and address why cilostazol does not significantly prolong bleeding time, despite its strong anti-platelet activity.
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Affiliation(s)
- Hideo Yagi
- Department of Hematology, Nara Hospital, Kinki University School of Medicine, Ikoma, Nara 630-0293, Japan.
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37
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Eikelboom JW, Hirsh J, Spencer FA, Baglin TP, Weitz JI. Antiplatelet drugs: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e89S-e119S. [PMID: 22315278 DOI: 10.1378/chest.11-2293] [Citation(s) in RCA: 252] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The article describes the mechanisms of action, pharmacokinetics, and pharmacodynamics of aspirin, dipyridamole, cilostazol, the thienopyridines, and the glycoprotein IIb/IIIa antagonists. The relationships among dose, efficacy, and safety are discussed along with a mechanistic overview of results of randomized clinical trials. The article does not provide specific management recommendations but highlights important practical aspects of antiplatelet therapy, including optimal dosing, the variable balance between benefits and risks when antiplatelet therapies are used alone or in combination with other antiplatelet drugs in different clinical settings, and the implications of persistently high platelet reactivity despite such treatment.
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Affiliation(s)
- John W Eikelboom
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada; Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada.
| | - Jack Hirsh
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada; Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
| | - Frederick A Spencer
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
| | - Trevor P Baglin
- Department of Haematology, Addenbrooke's NHS Trust, Cambridge, England
| | - Jeffrey I Weitz
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Thrombosis and Atherosclerosis Research Institute, Hamilton, ON, Canada
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Ansara AJ, Shiltz DL, Slavens JB. Use of Cilostazol for Secondary Stroke Prevention: An Old Dog with New Tricks? Ann Pharmacother 2012; 46:394-402. [DOI: 10.1345/aph.1q420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To evaluate the safety and efficacy of cilostazol for secondary prevention of non-cardioembolic ischemic stroke. Data Sources: PubMed and MEDLINE searches were performed (January 1970-September 2011) using the key words cilostazol, antiplatelet, aspirin, acetylsalicylic acid, secondary stroke prevention, ischemic stroke, intracerebral hemorrhage, intracranial, cerebrovascular accident, and transient ischemic attack. Additionally, reference citations from publications identified were reviewed. Study Selection and Data Extraction: Articles published in English and relevant primary literature evaluating the efficacy and safety of cilostazol in the secondary prevention of atherosclerotic ischemic stroke were included. Data Synthesis: Antiplatelet therapy plays a vital role in the multifaceted approach to secondary stroke prevention. Current American Heart Association/American Stroke Association clinical guidelines for secondary stroke prevention support the use of aspirin, Clopidogrel, and combination aspirin/extended-release dipyridamole. The antiplatelet, antithrombotic, and vasoditatory effects of cilostazol make it a potential alternative agent for atherosclerotic stroke prevention. Recent literature has demonstrated superior efficacy of cilostazol 100 mg twice daily for secondary stroke prevention compared to placebo and aspirin. Three clinical trials were reviewed (1 placebo-controlled, 2 aspirin-controlled), all of which were conducted in Japan or China. Cilostazol reduced the primary outcome of recurrence of stroke, with significantly fewer major bleeding events when compared to aspirin. Conclusions: Available literature suggests that cilostazol may be safer and more effective than aspirin in the secondary prevention of stroke in Asian patients. Further large-scale studies in more heterogeneous study populations are warranted to determine whether cilostazol is a viable therapeutic option for patients with a history of non-cardioembolic ischemic stroke.
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Affiliation(s)
- Alexander J Ansara
- Internal Medicine, Department of Pharmacy, Methodist Hospital (Indiana University Health); Associate Professor of Pharmacy Practice, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN
| | - Dane L Shiltz
- Family Medicine, Department of Pharmacy, Methodist Hospital (Indiana University Health); Assistant Professor of Pharmacy Practice, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University
| | - Jennifer B Slavens
- Internal Medicine, Department of Pharmacy, The Ohio State University Medical Center, Columbus, OH
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Nakamura T, Tsuruta S, Uchiyama S. Cilostazol combined with aspirin prevents early neurological deterioration in patients with acute ischemic stroke: A pilot study. J Neurol Sci 2012; 313:22-6. [DOI: 10.1016/j.jns.2011.09.038] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Revised: 09/24/2011] [Accepted: 09/28/2011] [Indexed: 10/16/2022]
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Lansberg MG, O'Donnell MJ, Khatri P, Lang ES, Nguyen-Huynh MN, Schwartz NE, Sonnenberg FA, Schulman S, Vandvik PO, Spencer FA, Alonso-Coello P, Guyatt GH, Akl EA. Antithrombotic and thrombolytic therapy for ischemic stroke: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e601S-e636S. [PMID: 22315273 PMCID: PMC3278065 DOI: 10.1378/chest.11-2302] [Citation(s) in RCA: 307] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2011] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES This article provides recommendations on the use of antithrombotic therapy in patients with stroke or transient ischemic attack (TIA). METHODS We generated treatment recommendations (Grade 1) and suggestions (Grade 2) based on high (A), moderate (B), and low (C) quality evidence. RESULTS In patients with acute ischemic stroke, we recommend IV recombinant tissue plasminogen activator (r-tPA) if treatment can be initiated within 3 h (Grade 1A) or 4.5 h (Grade 2C) of symptom onset; we suggest intraarterial r-tPA in patients ineligible for IV tPA if treatment can be initiated within 6 h (Grade 2C); we suggest against the use of mechanical thrombectomy (Grade 2C) although carefully selected patients may choose this intervention; and we recommend early aspirin therapy at a dose of 160 to 325 mg (Grade 1A). In patients with acute stroke and restricted mobility, we suggest the use of prophylactic-dose heparin or intermittent pneumatic compression devices (Grade 2B) and suggest against the use of elastic compression stockings (Grade 2B). In patients with a history of noncardioembolic ischemic stroke or TIA, we recommend long-term treatment with aspirin (75-100 mg once daily), clopidogrel (75 mg once daily), aspirin/extended release dipyridamole (25 mg/200 mg bid), or cilostazol (100 mg bid) over no antiplatelet therapy (Grade 1A), oral anticoagulants (Grade 1B), the combination of clopidogrel plus aspirin (Grade 1B), or triflusal (Grade 2B). Of the recommended antiplatelet regimens, we suggest clopidogrel or aspirin/extended-release dipyridamole over aspirin (Grade 2B) or cilostazol (Grade 2C). In patients with a history of stroke or TIA and atrial fibrillation we recommend oral anticoagulation over no antithrombotic therapy, aspirin, and combination therapy with aspirin and clopidogrel (Grade 1B). CONCLUSIONS These recommendations can help clinicians make evidence-based treatment decisions with their patients who have had strokes.
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Affiliation(s)
- Maarten G Lansberg
- Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA
| | - Martin J O'Donnell
- HRB-Clinical Research Faculty, National University of Ireland Galway, Galway, Ireland
| | - Pooja Khatri
- Department of Neurology, University of Cincinnati, Cincinnati, OH
| | | | | | - Neil E Schwartz
- Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA
| | - Frank A Sonnenberg
- Division of General Internal Medicine, UMDNJ/Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Sam Schulman
- Department of Medicine, McMaster University, ON, Canada
| | - Per Olav Vandvik
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | | | | | - Gordon H Guyatt
- Department of Medicine, McMaster University, ON, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Elie A Akl
- State University of New York at Buffalo, Buffalo, NY; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
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Bai Y, Muqier, Murakami H, Iwasa M, Sumi S, Yamada Y, Ushikoshi H, Aoyama T, Nishigaki K, Takemura G, Uno B, Minatoguchi S. Cilostazol protects the heart against ischaemia reperfusion injury in a rabbit model of myocardial infarction: focus on adenosine, nitric oxide and mitochondrial ATP-sensitive potassium channels. Clin Exp Pharmacol Physiol 2012; 38:658-65. [PMID: 21679220 DOI: 10.1111/j.1440-1681.2011.05550.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
1. The present study examined whether or not cilostazol reduces the myocardial infarct size, and investigated its mechanism in a rabbit model of myocardial infarction. 2. Japanese white rabbits underwent 30 min of coronary occlusion, followed by 48 h of reperfusion. Cilostazol (1 and 5 mg/kg) or vehicle was given intravenously 5 min before ischaemia. 8-p-sulfophenyl theophylline (8SPT; an adenosine receptor blocker, 7.5 mg/kg), Nω-nitro-L-arginine methylester (l-NAME; an NOS inhibitor, 10 mg/kg) or 5-hydroxydecanoic acid sodium salt (5-HD; a mitochondrial ATP-sensitive potassium (KATP) channel blocker, 5 mg/kg) was given intravenously 5 min before cilostazol injection. Infarct size was determined as a percentage of the risk area. 3. The myocardial interstitial levels of adenosine and nitrogen oxide (NOx) during ischaemia and reperfusion, and the intensity of myocardial dihydroethidium staining were determined. 4. Infarct size was significantly reduced in the cilostazol 1 mg/kg (38.4% (2.9%)) and cilostazol 5 mg/kg (30.7% (4.7%)) groups compared with that in the control group (46.5% (4.2%)). The infarct size-reducing effect of cilostazol was completely abolished by 8SPT (46.6% (3.5%)), L-NAME (49.0% (5.5%)), or 5HD (48.5% (5.1%)). 8SPT, L-NAME or 5HD alone did not affect the infarct size. Cilostazol treatment significantly increased myocardial levels of adenosine and NOx during ischaemia, and attenuated the intensity of dihydroethidium staining during reperfusion. 5. These findings show that cilostazol reduces the myocardial infarct size by increasing adenosine and NOx levels, attenuating superoxide production and opening the mitochondrial KATP channels. Cilostazol might provide a new strategy for the treatment of coronary heart disease.
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Affiliation(s)
- Yushan Bai
- Department of Cardiology, Gifu University Graduate School of Medicine, Gifu Pharmaceutical University, Gifu, Japan
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42
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Quantitative assessment of changes in carotid plaques during cilostazol administration using three-dimensional ultrasonography and non-gated magnetic resonance plaque imaging. Neuroradiology 2012; 54:939-45. [DOI: 10.1007/s00234-012-1011-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 01/11/2012] [Indexed: 11/26/2022]
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43
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Gresele P, Momi S, Falcinelli E. Anti-platelet therapy: phosphodiesterase inhibitors. Br J Clin Pharmacol 2012; 72:634-46. [PMID: 21649691 DOI: 10.1111/j.1365-2125.2011.04034.x] [Citation(s) in RCA: 199] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Inhibition of platelet aggregation can be achieved either by the blockade of membrane receptors or by interaction with intracellular signalling pathways. Cyclic adenosine 3',5'-monophosphate (cAMP) and cyclic guanosine 3',5'-monophosphate (cGMP) are two critical intracellular second messengers provided with strong inhibitory activity on fundamental platelet functions. Phosphodiesterases (PDEs), by catalysing the hydrolysis of cAMP and cGMP, limit the intracellular levels of cyclic nucleotides, thus regulating platelet function. The inhibition of PDEs may therefore exert a strong platelet inhibitory effect. Platelets possess three PDE isoforms (PDE2, PDE3 and PDE5), with different selectivity for cAMP and cGMP. Several nonselective or isoenzyme-selective PDE inhibitors have been developed, and some of them have entered clinical use as antiplatelet agents. This review focuses on the effect of PDE2, PDE3 and PDE5 inhibitors on platelet function and on the evidence for an antithrombotic action of some of them, and in particular of dipyridamole and cilostazol.
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Affiliation(s)
- Paolo Gresele
- Department of Internal Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy.
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44
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Srivastava K, Bath PMW, Bayraktutan U. Current therapeutic strategies to mitigate the eNOS dysfunction in ischaemic stroke. Cell Mol Neurobiol 2011; 32:319-36. [PMID: 22198555 DOI: 10.1007/s10571-011-9777-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 11/29/2011] [Indexed: 12/22/2022]
Abstract
Impairment of endothelial nitric oxide synthase (eNOS) activity is implicated in the pathogenesis of endothelial dysfunction in many diseases including ischaemic stroke. The modulation of eNOS during and/or following ischaemic injury often represents a futile compensatory mechanism due to a significant decrease in nitric oxide (NO) bioavailability coupled with dramatic increases in the levels of reactive oxygen species that further neutralise NO. However, applications of a number of therapeutic agents alone or in combination have been shown to augment eNOS activity under a variety of pathological conditions by potentiating the expression and/or activity of Akt/eNOS/NO pathway components. The list of these therapeutic agents include NO donors, statins, angiotensin-converting enzyme inhibitors, calcium channel blockers, phosphodiesterase-3 inhibitors, aspirin, dipyridamole and ellagic acid. While most of these compounds exhibit anti-platelet properties and are able to up-regulate eNOS expression in endothelial cells and platelets, others suppress eNOS uncoupling and tetrahydrobiopterin (an eNOS stabiliser) oxidation. As the number of therapeutic molecules that modulate the expression and activity of eNOS increases, further detailed research is required to reveal their mode of action in preventing and/or reversing the endothelial dysfunction.
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Affiliation(s)
- Kirtiman Srivastava
- Division of Stroke, Clinical Sciences Building, Nottingham City Hospital Campus, The University of Nottingham, Nottingham, UK.
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45
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Patrono C, Andreotti F, Arnesen H, Badimon L, Baigent C, Collet JP, De Caterina R, Gulba D, Huber K, Husted S, Kristensen SD, Morais J, Neumann FJ, Rasmussen LH, Siegbahn A, Steg PG, Storey RF, Van de Werf F, Verheugt F. Antiplatelet agents for the treatment and prevention of atherothrombosis. Eur Heart J 2011; 32:2922-32. [DOI: 10.1093/eurheartj/ehr373] [Citation(s) in RCA: 164] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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46
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Geng DF, Deng J, Jin DM, Wu W, Wang JF. Effect of cilostazol on the progression of carotid intima-media thickness: a meta-analysis of randomized controlled trials. Atherosclerosis 2011; 220:177-83. [PMID: 22015232 DOI: 10.1016/j.atherosclerosis.2011.09.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 09/15/2011] [Accepted: 09/27/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND It has been well established that cilostazol has anti-proliferative effect against in-stent restenosis. However, it remains unclear whether cilostazol can prevent the progression of carotid atherosclerosis. METHODS AND RESULTS We performed a meta-analysis of all relevant randomized controlled trials (RCTs) to evaluate the effect of cilostazol on the progression of carotid intima-media thickness (IMT). Five RCTs with 698 patients [597 subjects with type 2 diabetes mellitus (T2DM)] were included in this study. Cilostazol was associated with a significant reduction in the progression of carotid IMT (WMD, -0.08mm, 95% CI -0.13, -0.04; P=0.00003). Subgroup analysis shows that cilostazol monotherapy or addition to dual antiplatelet therapy (aspirin and clopidogrel) was superior to placebo (WMD, -0.04mm, 95% CI -0.05, -0.03; P<0.00001), no antiplatelet medication (WMD, -0.12mm, 95% CI -0.21, -0.03; P=0.008), aspirin monotherapy (WMD, -0.06mm, 95% CI -0.12, 0.00; P=0.04) or dual antiplatelet therapy (WMD, -0.16mm, 95% CI -0.30, -0.02; P=0.03) in preventing the progression of carotid IMT. Cilostazol resulted in a significant decrease in total cholesterol (WMD -8.47mg/dl, 95% CI -14.18, -2.75; P=0.004) and LDL-C (WMD -8.25mg/dl, 95% CI -14.15, -2.36; P=0.006) and favorable trends in reducing triglyceride (WMD -15.83mg/dl, 95% CI -32.14, 0.48; P=0.06). CONCLUSION It suggests that cilostazol may have beneficial effects in preventing the progression of carotid atherosclerosis and improving pro-atherogenic lipid profile, especially in patients with T2DM. Whether the anti-atherosclerotic effect of cilostazol is independent of improving pro-atherogenic dyslipidemia is worth further investigation.
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Affiliation(s)
- Deng-Feng Geng
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 West Yanjiang Road, Guangzhou 510120, China
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47
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Kwon SU, Hong KS, Kang DW, Park JM, Lee JH, Cho YJ, Yu KH, Koo JS, Wong KL, Lee SH, Lee KB, Kim DE, Jeong SW, Bae HJ, Lee BC, Han MK, Rha JH, Kim HY, Mok VC, Lee YS, Kim GM, Suwanwela NC, Yun SC, Nah HW, Kim JS. Efficacy and Safety of Combination Antiplatelet Therapies in Patients With Symptomatic Intracranial Atherosclerotic Stenosis. Stroke 2011; 42:2883-90. [DOI: 10.1161/strokeaha.110.609370] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sun U. Kwon
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Keun-Sik Hong
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Dong-Wha Kang
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Jong-Moo Park
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Ju-Hun Lee
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Yong-Jin Cho
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Kyung-Ho Yu
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Ja-Seong Koo
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - K.S. Lawrence Wong
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Seung-Hoon Lee
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Kyung Bok Lee
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Dong-Eog Kim
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Sang-Wook Jeong
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Hee-Joon Bae
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Byung-Chul Lee
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Moon-Ku Han
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Joung-Ho Rha
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Hahn Young Kim
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Vincent C. Mok
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Yong-Seok Lee
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Gyeong-Moon Kim
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Nijasri Charnnarong Suwanwela
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Sung-Cheol Yun
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Hyun-Wook Nah
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
| | - Jong S. Kim
- From the Asan Medical Center (S.U.K., D.W.K., H.W.N., J.S.K.), University of Ulsan, Ulsan, Korea; Ilsan Paik Hospital (Y.J.C.), Inje University, Inje, Korea; Eulji University (J.M.P.), Euliji, Korea; Kangdong Sacred Heart Hospital (J.H.L.), Seoul, Korea; Hallym University Sacred Heart Hospital (K.H.Y., B.C.L.), Seoul Korea; Seoul St. Mary's Hospital (J.S.K.), Catholic University of Korea, Seoul, Korea; Chinese University of Hong Kong (K.S.L.W., V.C.M.), Hong Kong, China; Seoul National University
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Reis F. Are threshold levels of signal transduction required for the protective effect of cilostazol against cardiac ischaemia-reperfusion injury? Clin Exp Pharmacol Physiol 2011; 38:651-3. [DOI: 10.1111/j.1440-1681.2011.05564.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Beneficial effect of anti-platelet therapies on atherosclerotic lesion formation assessed by phase-contrast X-ray CT imaging. Int J Cardiovasc Imaging 2011; 28:1181-91. [DOI: 10.1007/s10554-011-9910-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 06/10/2011] [Indexed: 11/30/2022]
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Kanlop N, Chattipakorn S, Chattipakorn N. Effects of cilostazol in the heart. J Cardiovasc Med (Hagerstown) 2011; 12:88-95. [PMID: 21200326 DOI: 10.2459/jcm.0b013e3283439746] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Cilostazol is a selective phosphodiesterase 3 (PDE3) inhibitor approved by the Food and Drug Administration for treatment of intermittent claudication. It has also been used in bradyarrhythmic patients to increase heart rates. Recently, cilostazol has been shown to prevent ventricular fibrillation in patients with Brugada syndrome. Cilostazol is hypothesized to suppress transient outward potassium (Ito) current and increase inward calcium current, thus, maintaining the dome (phase 2) of action potential, decreasing transmural dispersion of repolarization and preventing ventricular fibrillation. Although many PDE3 inhibitors have been shown to increase cardiac arrhythmia in heart failure, cilostazol has presented effects that are different from other PDE3 inhibitors, especially adenosine uptake inhibition. Owing to this effect, cilostazol could be an effective cardioprotective drug, with its beneficial effects in preventing arrhythmia. In this review, the cardiac electrophysiological effects of cilostazol are presented and its possible cardioprotective effects, particularly in preventing ventricular fibrillation, are discussed, with emphasis on the need to further verify its clinical benefits.
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Affiliation(s)
- Natnicha Kanlop
- Cardiac Electrophysiology Unit, Department of Physiology, Thailand
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