Lee SJ, et al. – The researchers compared the changes of flow–mediated dilation (FMD) between aspirin and cilostazol groups in patients with acute cerebral ischemia to assess the effect of cilostazol on endothelial function. In acute cerebral ischemia patients, cilostazol improved endothelial function. Furthermore, It also restored an inverse association between 3–month FMD and baseline L–arginine levels.

• The researchers randomly assigned patients presenting with acute cerebral ischemic events into aspirin (n = 40) or cilostazol (n = 40) group in a double-blinded manner.
• They measured FMD at baseline (T0) and 90 days (T1).
• At baseline, they measured L-arginine (a precursor of biologically active nitric oxides).
• They described serious and non-serious adverse events.

• The researchers found a significant increase of FMD values in cilostazol group (7.9 ± 2.4 to 8.9 ± 2.3%, p = 0.001) and not in aspirin group (8.5 ± 2.6 to 9.3 ± 2.8%, p = 0.108) despite no difference in the baseline FMD values (p = 0.363).
• Serum L–arginine levels were inversely correlated with FMD at T1 (β = -0.050, SE: 0.012, p < 0.001) with age, total cholesterol levels, and C-reactive protein as confounders, in the multiple regression analysis performed in cilostazol group.
• In both aspirin and cilostazol groups, while T0 FMD values did not show any correlation with serum L-arginine levels, the correlation is restored in the cilostazol group at T1 (r = 0.467, p = 0.007), while such is not shown in the aspirin group.
• They found no difference of serious adverse events between the two groups (p = 0.235).
• In the cilostazol group (35/40 vs. 25/40, p = 0.010), adverse events were more common due to frequent headaches (14/40 vs. 3/30, p = 0.003) which was well tolerated.