Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Data Science Center, Jichi Medical University, Tochigi, Japan.
Cerebrovasc Dis. 2024;53(2):152-159. doi: 10.1159/000531716. Epub 2023 Aug 16.
The association between the use of cilostazol as a post-stroke antiplatelet medication and a reduction in post-stroke pneumonia has been suggested. However, whether cilostazol has a greater preventive effect against post-stroke aspiration pneumonia (AP) than other antiplatelet medications remains unclear. Thus, this study aimed to evaluate whether cilostazol has a greater preventive effect against post-stroke AP than aspirin or clopidogrel.
Through the Japanese Diagnosis Procedure Combination database, we identified patients who were hospitalized for ischemic stroke between April 2012 and September 2019. We performed 1:1 propensity score matching between patients who received cilostazol alone at discharge and those who received aspirin or clopidogrel alone at discharge. The primary outcome was the 90-day readmission for post-stroke AP. The occurrence of recurrent ischemic stroke within 90 days was also evaluated.
Among the 305,543 eligible patients with ischemic stroke, 65,141 (21%), 104,157 (34%), and 136,245 (45%) received cilostazol, aspirin, and clopidogrel, respectively. Propensity score matching generated 65,125 pairs. The cilostazol group had a higher proportion of 90-day post-stroke readmissions with AP than the aspirin or clopidogrel groups (1.5% vs. 1.2%, p < 0.001). The proportion of patients with recurrent ischemic stroke within 90 days was also higher in the cilostazol group (2.4% vs. 2.2%, p = 0.017).
The present study suggests that cilostazol may not have a greater effect on preventing post-stroke AP within 90 days than other antiplatelet medications. Nevertheless, further randomized controlled trials with longer follow-up periods are warranted.
有研究表明，使用西洛他唑作为卒中后抗血小板药物与卒中后肺炎发生率降低有关。然而，西洛他唑是否比其他抗血小板药物更能预防卒中后吸入性肺炎（AP）尚不清楚。因此，本研究旨在评估西洛他唑是否比阿司匹林或氯吡格雷更能预防卒中后 AP。
通过日本诊断程序组合数据库，我们确定了 2012 年 4 月至 2019 年 9 月期间因缺血性卒中住院的患者。我们对出院时单独接受西洛他唑治疗的患者与出院时单独接受阿司匹林或氯吡格雷治疗的患者进行了 1:1 倾向评分匹配。主要结局为卒中后 90 天内再次因 AP 入院。还评估了 90 天内复发性缺血性卒中的发生情况。
在 305543 例符合条件的缺血性卒中患者中，分别有 65141 例（21%）、104157 例（34%）和 136245 例（45%）接受了西洛他唑、阿司匹林和氯吡格雷治疗。采用倾向评分匹配生成了 65125 对。西洛他唑组 90 天内卒中后因 AP 再次入院的比例高于阿司匹林或氯吡格雷组（1.5%比 1.2%，p < 0.001）。西洛他唑组 90 天内复发性缺血性卒中的比例也较高（2.4%比 2.2%，p = 0.017）。
本研究表明，西洛他唑在预防 90 天内卒中后 AP 方面的效果可能并不优于其他抗血小板药物。然而，需要进行更长随访时间的随机对照试验。
