Cilostazol is a selective inhibitor of
phosphodiesterase type III that downregulates
tenascin-C (TNC), a matricellular
protein, which may cause delayed
cerebral infarction after
aneurysmal subarachnoid hemorrhage (SAH). The authors increased the dosage and evaluated the dose-dependent effects of
cilostazol on delayed
cerebral infarction and outcomes in SAH patients. This was a retrospective cohort study in a single center. One hundred fifty-six consecutive SAH patients including 67 patients of admission World Federation of Neurological Surgeons grades IV-V who underwent aneurysmal obliteration within 48 h post-SAH from 2007 to 2017 were analyzed.
Cilostazol (0 to 300 mg/day) was administered from 1-day post-clipping or post-coiling to day 14 or later.
Cilostazol treatment dose-dependently decreased delayed
cerebral infarction and tended to improve outcomes, although
cilostazol did not affect other outcome measures including angiographic vasospasm. On multivariate analyses, 300 mg/day (100 mg three times)
cilostazol independently decreased delayed
cerebral infarction and improved 3-month outcomes, but other regimens including 200 mg/day (100 mg twice)
cilostazol were not independent prognostic factors. Propensity score-matched analyses showed that the 300 mg/day
cilostazol cohort had lower plasma TNC levels and a lower incidence of delayed
cerebral infarction associated with better outcomes compared with the non-
cilostazol cohort. The 300 mg/day
cilostazol may improve post-SAH outcomes by reducing plasma TNC levels and delayed
cerebral infarction, but not vasospasm. Further studies are warranted to investigate if 300 mg/day
cilostazol is more beneficial to post-SAH outcomes than a usual dose of 200 mg/day
cilostazol that was demonstrated to be effective in randomized controlled trials.