Long-Term Sequential Dual Antiplatelet Therapy Based on Cilostazol in Symptomatic Intracranial Arterial Stenosis: A Real-World Cohort Study (SPDACSIS-COH)
The Secondary Preventive Effect of Long-term Sequential Dual Antiplatelet Therapy Based on Cilostazol in Cerebral Infarction Patients With Symptomatic Moderate to Severe Intracranial Arterial Stenosis: A Real-World Cohort Study (SPDACSIS-COH)
This study aims to evaluate whether long-term dual antiplatelet therapy (DAPT) with cilostazol is associated with a lower risk of recurrent symptomatic ischemic stroke or all-cause mortality compared with single antiplatelet therapy (SAPT) in patients with symptomatic moderate-to-severe intracranial arterial stenosis following the completion of standard DAPT.
Studieoversikt
Status
Status
Forhold
Forhold
Intervensjon / Behandling
Intervensjon / Behandling
Detaljert beskrivelse
Patients with symptomatic intracranial arterial stenosis remain at high risk of recurrent stroke despite standard medical treatment. Although short-term DAPT is recommended, the optimal long-term antiplatelet strategy following standard treatment remains uncertain. Cilostazol-based DAPT may provide additional protection against recurrent ischemic events with an acceptable bleeding risk. Therefore, this real-world cohort study aims to evaluate the effectiveness and safety of long-term cilostazol-based DAPT compared with SAPT in patients with symptomatic moderate-to-severe intracranial arterial stenosis. Treatment strategies are determined according to routine clinical practice rather than assigned by the study protocol.
Studietype
Studietype
Registrering (Antatt)
Registrering
Kontakter og plasseringer
Studiekontakt
Studiekontakt
- Navn: Yongjun Cao, M.D, PhD
- Telefonnummer: +86 512 67784789
- E-post: yongjuncao@126.com
Studiesteder
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-
Jiangsu
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Suzhou, Jiangsu, Kina, 215004
- Rekruttering
- Second Affiliated Hospital of Soochow University
-
Ta kontakt med:
- Yongjun Cao, M.D, PhD
- Telefonnummer: +86 512 67784789
- E-post: yongjuncao@126.com
-
-
Deltakelseskriterier
Kvalifikasjonskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
Tar imot friske frivillige
Kjønn som er kvalifisert for studier
Prøvetakingsmetode
Studiepopulasjon
Patients with symptomatic intracranial atherosclerotic stenosis who have experienced a recent ischemic stroke or transient ischemic attack and completed 3 months of standard dual antiplatelet therapy. The cohort includes both retrospectively identified historical patients and prospectively enrolled patients who receive cilostazol-based dual antiplatelet therapy or single antiplatelet therapy according to routine clinical practice.
Beskrivelse
Inclusion Criteria:
- Age: 18-80 years old.
- Acute mild non-cardioembolic stroke.
- Ischemic stroke or transient ischemic attack (TIA) occurring 2 to 4 weeks prior to enrollment.
- NIHSS score ≤15 at enrollment and pre-stroke mRS score ≤2.
- Ischemic stroke or TIA attributable to the territory of the qualifying intracranial artery.
- Symptomatic 70%-99% intracranial atherosclerotic stenosis confirmed by DSA, CTA, or MRA.
Exclusion Criteria:
- High-risk cardioembolic source requiring or potentially requiring long-term anticoagulation, including persistent or paroxysmal atrial fibrillation, mechanical heart valve or severe valvular disease, intracardiac thrombus, recent myocardial infarction with significant wall-motion abnormality, or severe cardiomyopathy.
- Stroke or TIA caused by nonatherosclerotic disease, including moyamoya disease, vasculitis, arterial dissection, or other definite nonatherosclerotic causes.
- Known allergy or serious adverse reaction to cilostazol, aspirin, clopidogrel, ticagrelor, or other antiplatelet agents.
- Current or previous severe heart failure.
- Severe bleeding event within the previous 6 months, including spontaneous intracranial hemorrhage, major gastrointestinal bleeding, or other bleeding requiring blood transfusion.
- Significant bleeding tendency or coagulation abnormality.
- Medical condition requiring long-term oral anticoagulation.
- Active malignancy or other serious illness with a life expectancy of less than 1 year.
- Severe cognitive impairment or psychiatric illness that would prevent adherence to study treatment or long-term follow-up.
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Observasjonsmodeller: COHORT
- Tidsperspektiver: OTHER
Antall grupper / kohorter
Kohorter og intervensjoner
Gruppe / KohortGruppe / Kohort |
Intervensjon / BehandlingIntervensjon / Behandling |
|---|---|
|
Cilostazol-Based Dual Antiplatelet Therapy
Participants who receive cilostazol 50 mg twice daily in combination with aspirin 100 mg once daily, clopidogrel 75 mg once daily, or ticagrelor 90 mg twice daily for 12 months according to routine clinical practice. |
Participants receive cilostazol 50 mg twice daily in combination with aspirin 100 mg once daily, clopidogrel 75 mg once daily, or ticagrelor 90 mg twice daily according to routine clinical practice. |
|
Single Antiplatelet Therapy
Participants who receive single antiplatelet therapy with aspirin 100 mg once daily, clopidogrel 75 mg once daily, or ticagrelor 90 mg twice daily for 12 months according to routine clinical practice. |
Participants receive single antiplatelet therapy with aspirin 100 mg once daily, clopidogrel 75 mg once daily, or ticagrelor 90 mg twice daily according to routine clinical practice. |
Hva måler studien?
Primære resultatmål
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
Time to First Recurrent Symptomatic Ischemic Stroke or All-Cause Death
Tidsramme: From randomization through 12 months
|
Time from Day 90 randomization to the first occurrence of recurrent symptomatic ischemic stroke or death from any cause. |
From randomization through 12 months
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
Incidence of Any Stroke
Tidsramme: 12 months
|
Occurrence of any ischemic or hemorrhagic stroke during follow-up. |
12 months
|
|
Incidence of Hemorrhagic Stroke
Tidsramme: 12 months
|
Occurrence of symptomatic intracranial hemorrhage or subarachnoid hemorrhage. |
12 months
|
|
Incidence of Ischemic Stroke or Transient Ischemic Attack
Tidsramme: Time Frame
|
Occurrence of ischemic stroke or transient ischemic attack during follow-up. |
Time Frame
|
|
Modified Rankin Scale Score
Tidsramme: 12 months
|
Functional outcome assessed using the Modified Rankin Scale (mRS), ranging from 0 to 6. A score of 0 indicates no symptoms, whereas a score of 6 indicates death. Higher scores represent greater disability and worse functional outcomes.(0 = no symptoms; 1 = no significant disability despite symptoms; 2 = slight disability, unable to perform all previous activities but able to manage personal affairs without assistance; 3 = moderate disability, requiring some help but able to walk without assistance; 4 = moderately severe disability, unable to walk without assistance and unable to attend to bodily needs without assistance; 5 = severe disability, bedridden, incontinent, and requiring constant nursing care and attention; and 6 = death.) |
12 months
|
|
Incidence of All Vascular Events
Tidsramme: 12 months
|
Composite vascular events including stroke, myocardial infarction, and other vascular events such as aortic dissection, aortic rupture, pulmonary embolism, hospitalization for heart failure, angina or peripheral artery disease, and coronary, aortic, cervicocephalic, or peripheral arterial revascularization. |
12 months
|
Andre resultatmål
Andre resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
Major Bleeding
Tidsramme: 12 months
|
Number and proportion of participants who experience bleeding classified as Bleeding Academic Research Consortium (BARC) grade 3 or higher during follow-up. |
12 months
|
|
Incidence of Adverse Events
Tidsramme: 12 months
|
Occurrence of any adverse event during the 12-month treatment and follow-up period. |
12 months
|
|
Incidence of Cilostazol-Related Adverse Events Leading to Treatment Discontinuation
Tidsramme: 12 months
|
Number and proportion of participants in the cilostazol-based dual antiplatelet therapy group who discontinue cilostazol because of cilostazol-related adverse events, including headache, diarrhea, abnormal stools, palpitations, tachycardia, dizziness, or other adverse reactions considered related to cilostazol. |
12 months
|
Samarbeidspartnere og etterforskere
Sponsor
Sponsor
Studierekorddatoer
Studer hoveddatoer
Studiestart (Faktiske)
Studiestart
Primær fullføring (Antatt)
Primær fullføring
Studiet fullført (Antatt)
Studiet fullført
Datoer for studieregistrering
Først innsendt
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Faktiske)
Først lagt ut
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Sist oppdatering lagt ut
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Ytterligere relevante MeSH-vilkår
Andre studie-ID-numre
Andre studie-ID-numre
- LK2026004-COH
- SYW2026005 (Annet stipend/finansieringsnummer: SuZhou Municipal Health Commission)
Legemiddel- og utstyrsinformasjon, studiedokumenter
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