Cilostazol is a PDE3 (phosphodiesterase III) inhibitor with a long track record of safety that is Food and Drug Administration and European Medicines Agency approved for the treatment of claudication in patients with peripheral arterial disease. In addition, cilostazol has been approved for secondary stroke prevention in several Asian countries based on trials that have demonstrated a reduction in stroke recurrence among patients with noncardioembolic stroke. The onset of benefit appears after 60 to 90 days of treatment, which is consistent with cilostazol’s pleiotropic effects on platelet aggregation, vascular remodeling, blood flow, and plasma lipids. Cilostazol appears safe and does not increase the risk of major bleeding when given alone or in combination with aspirin or clopidogrel. Adverse effects such as headache, gastrointestinal symptoms, and palpitations, however, contributed to a 6% increase in drug discontinuation among patients randomized to cilostazol in a large secondary stroke prevention trial (CSPS.com [Cilostazol Stroke Prevention Study for Antiplatelet Combination]). Due to limitations of prior trials, such as open-label design, premature trial termination, large loss to follow-up, lack of functional or cognitive outcome data, and exclusive enrollment in Asia, the existing trials have not led to a change in clinical practice or guidelines in Western countries. These limitations could be addressed by a double-blind placebo-controlled randomized trial conducted in a broader population. If positive, it would increase the evidence in support of long-term treatment with cilostazol for secondary prevention in the millions of patients worldwide who have experienced a noncardioembolic ischemic stroke.

中文翻译：

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用于预防继发性卒中的西洛他唑

西洛他唑是一种 PDE3（磷酸二酯酶 III）抑制剂，具有长期的安全记录，被食品和药物管理局和欧洲药品管理局批准用于治疗外周动脉疾病患者的跛行。此外，西洛他唑已在几个亚洲国家被批准用于二级卒中预防，这些试验表明非心源性卒中患者的卒中复发率有所降低。治疗 60 至 90 天后开始出现获益，这与西洛他唑对血小板聚集、血管重塑、血流和血浆脂质的多效性作用一致。西洛他唑单独给药或与阿司匹林或氯吡格雷联合给药时似乎是安全的，不会增加大出血的风险。不良反应，如头痛、胃肠道症状、然而，在一项大型二级卒中预防试验（CSPS.com [Cilostazol Stroke Prevention Study for Antiplatelet Combination]）中，随机分配到西洛他唑组的患者停药率增加了 6%。由于先前试验的局限性，例如开放标签设计、试验提前终止、大量失访、缺乏功能或认知结果数据以及在亚洲独家招募，现有试验并未导致临床试验发生变化西方国家的实践或指南。这些限制可以通过在更广泛人群中进行的双盲安慰剂对照随机试验来解决。如果是阳性，