Effect of renal function on dual antiplatelet therapy using cilostazol for stroke prevention: a CSPS.com trial post hoc analysis

Background: The effect of renal function on long-term dual antiplatelet therapy using cilostazol for secondary stroke prevention is unknown. We investigated the effect of estimated glomerular filtration rate (eGFR) on the efficacy and safety of long-term dual antiplatelet therapy involving cilostazol. Methods: We performed a post hoc analysis of a multicenter, open-label, randomized controlled trial of patients with high-risk non-cardioembolic ischemic stroke who were randomly assigned to take aspirin or clopidogrel alone, or a combination of cilostazol with aspirin or clopidogrel and followed for 0.5–3.5 years. Patients were divided into three groups according to their baseline eGFR [normal or increased eGFR (≥90); mildly decreased eGFR (60–89); moderately decreased eGFR (<60 mL/min/1.73m²)]. Results: A total of 1749 patients with complete eGFR data were included. The recurrence of ischemic stroke was less common with dual therapy than with monotherapy in patients with mildly decreased eGFR (adjusted HR, 0.35; 95 % CI, 0.19–0.66), but there was no difference between dual therapy and monotherapy in patients with moderately decreased eGFR (0.78; 0.34–1.82) or in those with normal or increased eGFR (0.48; 0.14–1.64). Conclusions: Long-term dual antiplatelet therapy with cilostazol was more efficacious in decreasing recurrent ischemic stroke than monotherapy for patients with mildly decreased eGFR, but not for those with moderately decreased eGFR or those with normal or increased eGFR. Trial Registration Information: ClinicalTrials.gov