The anti-clotting drug cilostazol is as good as aspirin at preventing recurrent stroke and it causes less bleeding in the brain, a study by researchers at Peking University First Hospital in Beijing shows.

The trial included 360 patients stroke patients who took cilostazol for 12 to 18 months and 359 patients who took aspirin for the same length of time. Twelve patients in the cilostazol group and 20 patients in the aspirin group suffered recurrent stroke.

The researchers calculated that cilostazol reduced the risk of recurrent stroke by 38 percent, which is not statistically significant. But they also found that far fewer brain bleeding events occurred in the cilostazol group (one patient) than in the aspirin group (seven patients), which was statistically significant.

“The lower rates of ischemic and hemorrhagic stroke in the cilostazol group suggests that cilostazol might be a more effective and safer alternative to aspirin for Chinese patients with ischemic stroke; however, a larger phase III trial is required to confirm this,” the researchers wrote.

Stroke is the second leading cause of death in China. While aspirin is effective for preventing recurrent stroke, Asian people are more likely than others to suffer brain bleeding when taking aspirin, and the incidence of such bleeds in China is higher than in high-income nations. Cilostazol works through a different mechanism than aspirin.

The study appears online Monday in The Lancet Neurology, and will be published in the June print edition of the journal.

“The implications of these results for clinicians are that they offer hope for a safer antiplatelet [anti-clotting] drug that is at least as effective as aspirin for use in patients with ischemic stroke,” Dr. Graeme J. Hankey, department of neurology, Royal Perth Hospital in Australia, wrote in an accompanying editorial.

(Source: The Lancet Neurology, News Release, May 5, 2008)