CILO-CLOP Trial: Cilostazol Versus Clopidogrel in Acute Moderate and Moderate-to-Severe Ischemic Stroke: A Randomized Controlled Multicenter Trial
Abstract Introduction All large studies evaluating the role of cilostazol versus other antiplatelet agents in stroke prevention have been conducted in Asia and included patients with minor stroke or transient ischemic attack (TIA). Ours is the first-ever trial to evaluate the safety and efficacy of...
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Adis, Springer Healthcare
2025-04-01
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| Series: | Neurology and Therapy |
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| Online Access: | https://doi.org/10.1007/s40120-025-00739-5 |
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| author | Mohamed G. Zeinhom Mohamed Ismaiel Mohamed Fouad Elsayed Khalil Mohamed Ahmed Almoataz Tarek Youssif Omar Ahmed Mohamed Ali Daabis Hossam Mohamed Refat Ahmed Ahmed Mohamed Kamal Ebied Noha Abdelwahed Ahmed Zaki Omar Akl Emad Labib Abdelhamid Mahmoud Salah Ibrahim Ahmed Sherihan Rezk Ahmed |
| author_facet | Mohamed G. Zeinhom Mohamed Ismaiel Mohamed Fouad Elsayed Khalil Mohamed Ahmed Almoataz Tarek Youssif Omar Ahmed Mohamed Ali Daabis Hossam Mohamed Refat Ahmed Ahmed Mohamed Kamal Ebied Noha Abdelwahed Ahmed Zaki Omar Akl Emad Labib Abdelhamid Mahmoud Salah Ibrahim Ahmed Sherihan Rezk Ahmed |
| author_sort | Mohamed G. Zeinhom |
| collection | DOAJ |
| description | Abstract Introduction All large studies evaluating the role of cilostazol versus other antiplatelet agents in stroke prevention have been conducted in Asia and included patients with minor stroke or transient ischemic attack (TIA). Ours is the first-ever trial to evaluate the safety and efficacy of cilostazol versus clopidogrel in moderate and moderate-to-severe ischemic stroke in North Africa. Accordingly, in this study we assess the role of cilostazol as an alternative to clopidogrel in Egyptian patients with first-ever non-cardioembolic moderate or moderate-to-severe ischemic stroke. Methods A total of 870 patients with moderate and moderate-to-severe acute ischemic stroke (AIS) were randomly assigned to administration of loading and maintenance doses of cilostazol or clopidogrel. Results Of the 870 patients included in our trial, 37 (8.7%) in the cilostazol arm and 59 (13.6%) in the clopidogrel arm experienced a new stroke (HR 0.53; 95% CI, 0.33–0.84; P = 0.007). Twelve participants (2.8%) in the cilostazol group and 25 patients (5.7%) in the clopidogrel group experienced drug-related hemorrhagic complications (HR 0.25; 95% CI, 0.12–0.53; P = 0.001). Patients with hypertension who received cilostazol had significantly lower rates of recurrent hemorrhagic and ischemic stroke. Conclusion Egyptian patients with non-cardioembolic moderate and moderate-to-severe ischemic stroke who received cilostazol within the first 24 h of symptoms had significantly lower rates of hemorrhagic transformation of brain infarction and peripheral hemorrhagic complications than those who received clopidogrel. Patients with hypertension achieved the greatest benefit from cilostazol, as they experienced a significant reduction in recurrent ischemic and hemorrhagic infarction. There were no significant differences between the two groups regarding the modified Rankin scale (mRS) score after 3 months or in the non-hemorrhagic side effects. Our results were derived from a single-blinded study; a more extensive, double-blinded, multinational study is needed for the results to be generalizable worldwide. Trial Registration: Retrospectively registered, ClinicalTrials.gov, NCT06242132, 27-01-2024. |
| format | Article |
| id | doaj-art-d03bebca5da74526a014b9f95ab97a78 |
| institution | Kabale University |
| issn | 2193-8253 2193-6536 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Adis, Springer Healthcare |
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| series | Neurology and Therapy |
| spelling | doaj-art-d03bebca5da74526a014b9f95ab97a782025-08-20T03:47:45ZengAdis, Springer HealthcareNeurology and Therapy2193-82532193-65362025-04-0114392794810.1007/s40120-025-00739-5CILO-CLOP Trial: Cilostazol Versus Clopidogrel in Acute Moderate and Moderate-to-Severe Ischemic Stroke: A Randomized Controlled Multicenter TrialMohamed G. Zeinhom0Mohamed Ismaiel1Mohamed Fouad Elsayed Khalil2Mohamed Ahmed Almoataz3Tarek Youssif Omar4Ahmed Mohamed Ali Daabis5Hossam Mohamed Refat6Ahmed Ahmed Mohamed Kamal Ebied7Noha Abdelwahed8Ahmed Zaki Omar Akl9Emad Labib Abdelhamid Mahmoud10Salah Ibrahim Ahmed11Sherihan Rezk Ahmed12Neurology Department, Faculty of Medicine, Kafr El-Sheikh UniversityNeurology Department, Al-Sahel Teaching HospitalNeurology Department, NMC Royal HospitalNeurology Department, Saudi German HospitalNeurology Department, Burjeel Medical CentersNeurology Department, Burjeel Royal HospitalNeurology Department, Faculty of Medicine Zagazig UniversityNeurology Department, Faculty of Medicine Zagazig UniversityNeurology Department, Emirates Hospital GroupNeurology Department, Faculty of Medicine, Ain Shams UniversityCardiology Department, National Heart InstituteNeurology Department, Faculty of Medicine, Al-Azhar UniversityNeurology Department, Faculty of Medicine, Kafr El-Sheikh UniversityAbstract Introduction All large studies evaluating the role of cilostazol versus other antiplatelet agents in stroke prevention have been conducted in Asia and included patients with minor stroke or transient ischemic attack (TIA). Ours is the first-ever trial to evaluate the safety and efficacy of cilostazol versus clopidogrel in moderate and moderate-to-severe ischemic stroke in North Africa. Accordingly, in this study we assess the role of cilostazol as an alternative to clopidogrel in Egyptian patients with first-ever non-cardioembolic moderate or moderate-to-severe ischemic stroke. Methods A total of 870 patients with moderate and moderate-to-severe acute ischemic stroke (AIS) were randomly assigned to administration of loading and maintenance doses of cilostazol or clopidogrel. Results Of the 870 patients included in our trial, 37 (8.7%) in the cilostazol arm and 59 (13.6%) in the clopidogrel arm experienced a new stroke (HR 0.53; 95% CI, 0.33–0.84; P = 0.007). Twelve participants (2.8%) in the cilostazol group and 25 patients (5.7%) in the clopidogrel group experienced drug-related hemorrhagic complications (HR 0.25; 95% CI, 0.12–0.53; P = 0.001). Patients with hypertension who received cilostazol had significantly lower rates of recurrent hemorrhagic and ischemic stroke. Conclusion Egyptian patients with non-cardioembolic moderate and moderate-to-severe ischemic stroke who received cilostazol within the first 24 h of symptoms had significantly lower rates of hemorrhagic transformation of brain infarction and peripheral hemorrhagic complications than those who received clopidogrel. Patients with hypertension achieved the greatest benefit from cilostazol, as they experienced a significant reduction in recurrent ischemic and hemorrhagic infarction. There were no significant differences between the two groups regarding the modified Rankin scale (mRS) score after 3 months or in the non-hemorrhagic side effects. Our results were derived from a single-blinded study; a more extensive, double-blinded, multinational study is needed for the results to be generalizable worldwide. Trial Registration: Retrospectively registered, ClinicalTrials.gov, NCT06242132, 27-01-2024.https://doi.org/10.1007/s40120-025-00739-5CilostazolEgyptClopidogrelModerate ischemic strokeModerate-to-severe stroke |
| spellingShingle | Mohamed G. Zeinhom Mohamed Ismaiel Mohamed Fouad Elsayed Khalil Mohamed Ahmed Almoataz Tarek Youssif Omar Ahmed Mohamed Ali Daabis Hossam Mohamed Refat Ahmed Ahmed Mohamed Kamal Ebied Noha Abdelwahed Ahmed Zaki Omar Akl Emad Labib Abdelhamid Mahmoud Salah Ibrahim Ahmed Sherihan Rezk Ahmed CILO-CLOP Trial: Cilostazol Versus Clopidogrel in Acute Moderate and Moderate-to-Severe Ischemic Stroke: A Randomized Controlled Multicenter Trial Neurology and Therapy Cilostazol Egypt Clopidogrel Moderate ischemic stroke Moderate-to-severe stroke |
| title | CILO-CLOP Trial: Cilostazol Versus Clopidogrel in Acute Moderate and Moderate-to-Severe Ischemic Stroke: A Randomized Controlled Multicenter Trial |
| title_full | CILO-CLOP Trial: Cilostazol Versus Clopidogrel in Acute Moderate and Moderate-to-Severe Ischemic Stroke: A Randomized Controlled Multicenter Trial |
| title_fullStr | CILO-CLOP Trial: Cilostazol Versus Clopidogrel in Acute Moderate and Moderate-to-Severe Ischemic Stroke: A Randomized Controlled Multicenter Trial |
| title_full_unstemmed | CILO-CLOP Trial: Cilostazol Versus Clopidogrel in Acute Moderate and Moderate-to-Severe Ischemic Stroke: A Randomized Controlled Multicenter Trial |
| title_short | CILO-CLOP Trial: Cilostazol Versus Clopidogrel in Acute Moderate and Moderate-to-Severe Ischemic Stroke: A Randomized Controlled Multicenter Trial |
| title_sort | cilo clop trial cilostazol versus clopidogrel in acute moderate and moderate to severe ischemic stroke a randomized controlled multicenter trial |
| topic | Cilostazol Egypt Clopidogrel Moderate ischemic stroke Moderate-to-severe stroke |
| url | https://doi.org/10.1007/s40120-025-00739-5 |
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