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Dual Therapy with Aspirin and Cilostazol May Improve Platelet Aggregation in Noncardioembolic Stroke Patients: A
Yoichi Ohnuki1, Yuko Ohnuki2, Saori Kohara1
1Division of Neurology, Department of Internal Medicine, Tokai University School of Medicine, Japan.
Insights
Dual therapy with aspirin and cilostazol showed potential clinical benefit for secondary stroke prevention by inhibiting platelet aggregation, similar to aspirin alone. Further research is needed to understand the underlying mechanisms.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Previous studies suggest clinical benefits of dual antiplatelet therapy (aspirin and cilostazol) for secondary stroke prevention.
- The precise physiological mechanisms underlying this benefit remain largely unknown.
- Understanding the impact on platelet and endothelial function is crucial for optimizing stroke treatment strategies.
Purpose of the Study:
- To investigate the effects of aspirin/cilostazol therapy on platelet and endothelial function in acute noncardioembolic ischemic stroke patients.
- To compare these effects against treatment with aspirin alone.
- To elucidate potential mechanisms for the clinical benefits of dual antiplatelet therapy.
Main Methods:
- A randomized prospective pilot study involving 24 patients with acute noncardioembolic ischemic stroke.
- Patients were assigned to receive either aspirin alone (A group) or aspirin plus cilostazol (CA group).
- Measurements included platelet aggregation, platelet activation, and levels of thrombomodulin (TM), hs-CRP, ICAM-1, VCAM-1, and vWF over 4 weeks.
Main Results:
- No significant differences in overall platelet function or activation were observed between the aspirin and aspirin/cilostazol groups.
- Platelet aggregation induced by adenosine diphosphate (ADP) decreased significantly from pre-treatment levels in the aspirin/cilostazol group at 2 and 4 weeks.
- No significant reductions in endothelial biomarkers (TM, hs-CRP, ICAM-1, VCAM-1, vWF) were found in either treatment group.
Conclusions:
- Dual therapy with aspirin and cilostazol demonstrated an inhibition of platelet aggregation compared to pre-treatment values, comparable to aspirin monotherapy.
- While no significant differences in platelet activation or endothelial markers were found, the observed inhibition of platelet aggregation suggests potential clinical utility.
- This study provides preliminary evidence supporting the use of dual aspirin and cilostazol therapy in managing noncardioembolic ischemic stroke.
Abstract:
Objective Some previous studies have found clinical benefit of dual antiplatelet therapy with aspirin and cilostazol for prevention of secondary stroke, but the physiological mechanism involved remains unknown. We aimed to clarify the effects of aspirin/cilostazol therapy on the platelet and endothelial functions of patients with acute noncardioembolic ischemic stroke, in comparison to patients who were treated with aspirin alone. Methods The present randomized prospective pilot study enrolled 24 patients within a week after the onset of noncardioembolic ischemic stroke. The patients were randomly allocated to receive aspirin (100 mg/day) (A group; 11 patients) or cilostazol (200 mg/day) plus aspirin (100 mg/day) (CA group; 13 patients). We measured platelet aggregation, platelet activation, and the thrombomodulin (TM), highly sensitive C-reactive protein (hs-CRP), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and von Willebrand (vWF) antigen levels and vWF activity over a 4-week period after enrollment. Results There was no significant difference in the platelet functions of the A and CA groups. However, the platelet aggregation induced by adenosine diphosphate (ADP) was decreased at 2 and 4 weeks (p<0.05) after treatment in comparison to the pre-treatment values in the CA group, but not in the A group. Platelet activation, and the hs-CRP, TM, ICAM-1, VCAM-1 and vWF values did not significantly decrease after treatment in either group. Conclusion Although there were no significant differences in platelet aggregation, platelet activation or the endothelial biomarker levels of the A and CA groups, dual therapy with aspirin and cilostazol inhibited platelet aggregation in comparison to the pre-treatment values, similarly to patients who received aspirin alone. This may suggest the clinical usefulness of dual therapy with aspirin and cilostazol in the treatment of patients with noncardioembolic ischemic stroke.
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