{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T20:43:46Z","timestamp":1788468226286,"version":"build-2803163510"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:sec>\n            <jats:title>Background and Purpose\u2014<\/jats:title>\n            <jats:p>Although cilostazol has shown less hemorrhagic events than aspirin, only marginal difference was observed in hemorrhagic stroke events among patients at high risk for cerebral hemorrhage. To identify patients who would most benefit from cilostazol, this study analyzed interactions between treatment and subgroups of the PICASSO trial (Prevention of Cardiovascular Events in Asian Ischemic Stroke Patients With High Risk of Cerebral Hemorrhage).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods\u2014<\/jats:title>\n            <jats:p>Ischemic stroke patients with a previous intracerebral hemorrhage or multiple microbleeds were randomized to treatment with cilostazol or aspirin and followed up for a mean 1.8 years. Efficacy, defined as the composite of any stroke, myocardial infarction, and vascular death, and safety, defined as the incidence of hemorrhagic stroke, were analyzed in the 2 groups. Interactions between treatment and age, sex, presence of hypertension and diabetes mellitus, index of high-risk cerebral hemorrhage, and white matter lesion burden were analyzed for primary and key secondary outcomes. Changes in vital signs and laboratory results were compared in the 2 groups.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\u2014<\/jats:title>\n            <jats:p>\n              Among all 1534 patients enrolled, a significant interaction between treatment group and index of high risk for cerebral hemorrhage on hemorrhagic stroke (\n              <jats:italic>P<\/jats:italic>\n              for interaction, 0.03) was observed. Hemorrhagic stroke was less frequent in the cilostazol than in the aspirin group in patients with multiple microbleeds (1 versus 13 events; hazard ratio, 0.08 [95% CI, 0.01\u20130.61];\n              <jats:italic>P<\/jats:italic>\n              =0.01). A marginal interaction between treatment group and white matter change on any stroke (\n              <jats:italic>P<\/jats:italic>\n              for interaction, 0.08) was observed. Cilostazol reduced any stroke significantly in patients with mild (5 versus 16 events; hazard ratio, 0.36 [95% CI, 0.13\u20130.97];\n              <jats:italic>P<\/jats:italic>\n              =0.04)-to-moderate (16 versus 32 events; hazard ratio, 0.50 [95% CI, 0.29\u20130.92];\n              <jats:italic>P<\/jats:italic>\n              =0.03) white matter changes. Heart rate and HDL (high-density lipoprotein) cholesterol level were significantly higher in the cilostazol group than in the aspirin group at follow-up.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Cilostazol may be more beneficial for ischemic stroke patients with multiple cerebral microbleeds and before white matter changes are extensive.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Registration\u2014<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT01013532.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.119.023855","type":"journal-article","created":{"date-parts":[[2019,12,20]],"date-time":"2019-12-20T10:00:21Z","timestamp":1576836021000},"page":"931-937","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":28,"title":["Cilostazol Versus Aspirin in Ischemic Stroke Patients With High-Risk Cerebral Hemorrhage"],"prefix":"10.1161","volume":"51","author":[{"given":"Bum Joon","family":"Kim","sequence":"first","affiliation":[{"name":"From the Department of Neurology, Kyung Hee University Medical Center, Seoul, Korea (B.J.K., S.H.H.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sun U.","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Neurology (S.U.K., D.-W.K.), Asan Medical Center, Ulsan University, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joung-Ho","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hanyang University, Myongji Hospital, Seoul, Korea (J.-H.P.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong-Jae","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology, Eunpyeong St. Mary\u2019s Hospital, The Catholic University of Korea, Seoul (Y.-J.K.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keun-Sik","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea (K.-S.H.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence K.S.","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Medicine and Therapeutics, Chinese University of Hong Kong (L.K.S.W.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sungwook","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Anam Hospital (S.Y.), Korea University, Seoul"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang-Ha","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Kyungpook National University Hospital, Daegu, Korea (Y.-H.H.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Sung","family":"Lee","sequence":"additional","affiliation":[{"name":"Clinical Research Center (J.S.L.), Asan Medical Center, Ulsan University, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juneyoung","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Biostatistics (J.L.), Korea University, Seoul"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong-Ho","family":"Rha","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inha University Hospital, Incheon, Korea (J.-H.R.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Hyuk","family":"Heo","sequence":"additional","affiliation":[{"name":"From the Department of Neurology, Kyung Hee University Medical Center, Seoul, Korea (B.J.K., S.H.H.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seong Hwan","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Neurology, Chosun University Hospital, Gwangju, Korea (S.H.A.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Woo-Keun","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Neurology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea (W.-K.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong-Moo","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea (J.-M.P.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju-Hun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurology, Sacred Heart Hospital, Hallym University, Seoul, Korea (J.-H.L.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jee-Hyun","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Neurology, Ulsan University Hospital, Ulsan University, Korea (J.-H.K.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung-Il","family":"Sohn","sequence":"additional","affiliation":[{"name":"Department of Neurology, Dongsan Medical Center, Keimyung University, Daegu, Korea (S.-I.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Man","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Neurology, Ansan Hospital (J.-M.J.), Korea University, Seoul"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose C.","family":"Navarro","sequence":"additional","affiliation":[{"name":"Department of Neurology and Psychiatry, University of Santo Tomas Hospital, Manila, Philippines (J.C.N.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hahn Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology, Konkuk University School of Medicine, Seoul, Korea (H.Y.K.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eung-Gyu","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea (E.-G.K.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seongheon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology, Kangwon National University Hospital, Chuncheon, Korea (S.K.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae-Kwan","family":"Cha","sequence":"additional","affiliation":[{"name":"Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Man-Seok","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurology, Chonnam National University Medical School, Gwangju, Korea (M.-S.P.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyo Suk","family":"Nam","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yonsei University Severance Hospital, Seoul, Korea 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