The antiplatelet drug cilostazol is at least as effective as aspirin — and may even surpass aspirin’s efficacy — in preventing secondary stroke, according to an industry-funded, noninferiority trial in the Lancet Neurology. Commentators note that the findings need verification in a more diverse population.

The CSPS 2 study investigators randomized some 2700 Japanese patients with recent noncardioembolic ischemic stroke to daily regimens consisting of either 200 mg of cilostazol or 81 mg of aspirin. The primary outcome was the occurrence of stroke, defined as cerebral infarction, cerebral hemorrhage, or subarachnoid hemorrhage. During a mean follow-up of roughly 2.5 years, patients on cilostazol had a lower annual incidence of stroke than those on aspirin (2.8% vs. 3.7%), as well as fewer hemorrhagic events.

Commentators warn that the generalizability of the findings is limited, owing to the homogeneous East Asian population studied.