Vascular dementia

Cilostazol

Cilostazol is a phosphodiesterase III inhibitor which suppresses cyclic adenosine monophosphate (cAMP) degradation. This results in increased cAMP levels in platelets and blood vessels, with antithrombotic and vasodilatory effects. One randomized controlled trial conducted in Japan showed a 39.8% reduction in risk of recurrent stroke in people with a previous lacunar infarction who were treated with cilostazol, compared with placebo.[124]Gotoh F, Tohgi H, Hirai S, et al. Cilostazol stroke prevention study: a placebo-controlled double-blind trial for secondary prevention of cerebral infarction. J Stroke Cerebrovasc Dis. 2000 Jul-Aug;9(4):147-57. http://www.ncbi.nlm.nih.gov/pubmed/24192020?tool=bestpractice.com ​ A subsequent trial compared cilostazol with aspirin for prevention of recurrent stroke. Cilostazol was noninferior to aspirin for recurrent stroke prevention, but was associated with a higher incidence of adverse events, including headache, dizziness, tachycardia, palpitations, and diarrhea.[125]Shinohara Y, Katayama Y, Uchiyama S, et al. Cilostazol for prevention of secondary stroke (CSPS 2): an aspirin-controlled, double-blind, randomised non-inferiority trial. Lancet Neurol. 2010 Oct;9(10):959-68. http://www.ncbi.nlm.nih.gov/pubmed/20833591?tool=bestpractice.com ​ Further studies are needed.