Cilostazol Verse Aspirin For Vascular Dementia In Poststroke Patients With White Matter Lesions (CAVAD)

Objective: Cilostazol , a phosphodiesterase (PDE III) inhibitor, plays a roal in inhbition of platelet aggregating, thrombosis forming and so on. Cilostazol has been designated as a standard medication for secondary prevention of stroke by the China guideline for cerebralvascular disease prevention and treatment which is appointed by Chinese Medical Association guidelines and the Chinese in 2007. A large number of studies have shown that long-term use of cilostazol for the secondary prevention of cerebral infarction is effective and safe. However, research of the cilostazol treatment of poststroke vascular dementia combined white matter lesions is little. This test was cilostazol treatment of cerebral white matter lesions in patients with vascular dementia in prospective studies , using modern technology objectively verificates its treatment of mild to moderate vascular dementia clinical effects.Acrroding to control with Aspirin enteric-coated tablets evaluats cilostazol treatment of white matter lesions of vascular dementia leading to the validity and effectiveness of relapse prevention and long-term drug safety.Method: In this study, aspirin as the control ,studying patients of vascular dementia in poststroke combined with white matter lesions is prospective, randomized, double-blind clinical trial. Delivery method cilostazol 200mg per day (50mg / tablets, 2 tablets / time, 2 times a day, oral after breakfast and supper); aspirin enteric-coated tablets 100mg / day (50mg / tablets, 2 tablets / times, one time a day, oral after breakfast ), for 12 months. A total of 52 cases of eligible patients were randomly divided into test group (cilostazol group of 26 cases) and the control group (aspirin group of 26 cases). Right into the patients once every 2 months follow-up, which including cerebral infarction recurrence, bleeding events and adverse events recorded and related laboratory tests to determine patient compliance. Using cognitive function scale (MoCA, MMSE, computer memory interference test score, etc.) evaluates patients before treatment and after treatment for 6 months and 12 months of the safety aspects.Drug safety includes the recurrence of cerebral infarction, cerebral hemorrhage and other adverse events.Results: 47 patients completed the final test, in which cilostazol group of 24 cases and aspirin group of 23 cases. The test group's improvement of therapy after 6 months and 12 months was higher than the same period in the control group, the difference was statistically significant (p <0.05). Test group of patients with MMSE, MoCA score significantly improved after treatment, and the difference was statistically significant (p <0.05), and a computer interference test score after treatment for 6 months no significant differences (p> 0.05), while the treatment of 12 months after the computer memory interference test score more than that before treatment were statistically significant. MMSE score in control group before and after treatment in patients with no significant difference (p> 0.05), while the MoCA score 6 months after treatment compared with those before treatment has improved, the difference was statistically significant (p <0.05). Computer Interference Test score ratings after 12 months compared with before treatment to reduce the difference was statistically significant (P <0.05). The two groups before treatment in patients with MMSE, MoCA, computer memory interference test score showed no significant difference (p> 0.05), treatment for 6 months and 12 months after the comparison MMSE, MoCA, and computer memory interference test score increase in value were statistically significant ( p <0.05). For security, each one cases of cerebral infarction recurrence of the two groups, the recurrence rate is relatively no significant differences (p> 0.05). Aspirin group of hemorrhagic events (cerebral hemorrhage, gingival bleeding) of cilostazol group than in the high incidence of the difference was statistically significant (p <0.05). Cilostazol group of common adverse reactions include headache, dizziness, tachycardia, leg edema, skin rash, diarrhea, stomach pain, etc, in which headache, tachycardia higher incidence than the aspirin group, the difference was statistically significant (p <0.05), but generally mild to moderate, through the reduction and adaptation 1-2 weeks without treatment the symptoms may disappear or ease, and only 1 patient discontinued treatment so. Most of the other adverse reactions were considered drug related. Although bleeding events were considered that it's may not be related to aspirin, but it also indicates that the security of cilostazol seems better than aspirin.Conclusion: Aspirin for treating post-stroke white matter lesions leading to vascular dementia is of no obvious effect and would not improve cognitive function of patients. Cilostazol can significantly improve cognitive function of patients with mild to moderate vascular dementia,and its treatment effection of vascular dementia combined with white matter lesions is superior to aspirin. Effect of cilostazol in the prevention of recurrence of cerebral infarction with aspirin is equally with aspirin, and it is of light adverse reactions , less bleeding events, and better security.