Cilostazol is Effective to Prevent Stroke-Associated Pneumonia in Patients Receiving Tube Feeding
Stroke-associated pneumonia (SAP) is a frequent complication in acute ischemic stroke (IS) patients, especially those receiving tube feeding (TF). In this retrospective study, we investigated whether or not cilostazol, a pluripotent phosphodiesterase III-specific inhibitor with anti-platelet and vasculogenic effects, can prevent SAP in these patients and reduce their duration of stay in intensive care unit/hospitalization. We recruited 158 IS patients receiving TF. Patients’ characteristics (including age, gender, past history), National Institute of Health Stroke Scale and serum albumin level on admission, concomitant medications associated with SAP prevention (including cilostazol), and stroke characteristics (bilateral subcortical white matter lesion, brainstem involvement, large infarction, and asymptomatic hemorrhagic infarction) were compared between the SAP(−) and SAP(+) groups. Cilostazol was more frequently used in the SAP(−) group (20.8% vs. 6.1%, p < 0.05). Duration of intensive care unit was longer in patients with SAP (9 ± 8 vs. 6 ± 6 days, p < 0.05). However, the length of stay in an intensive care unit and duration of hospitalization were not reduced due to the prevention of SAP by cilostazol treatment. Cilostazol administration was associated with reduced SAP incidence in acute IS patients receiving TF.
KeywordsCilostazol Stroke-associated pneumonia Ischemic stroke Aspiration pneumonia Tube feeding Nutrition
We thank M. Takada for helping to obtain approval from the ethics committee and M. Mizuma for awarding “incentive award” to us at the 21st annual meeting of Japanese Society of Dysphagia Rehabilitation.
SN and AM wrote the article and prepared the figures and tables. Data collection was performed by SN, AM, MS, and SY. Data analysis was performed by AM. EN and ST developed the study design, and revised the manuscript. All authors approved the final version.
Compliance with Ethical Standards
Conflict of interest
The authors state that they have no conflict of interest.
Informed consent was obtained from all individual participants included in the study.
- 6.Ribeiro PW, Cola PC, Gatto AR, da Silva RG, Luvizutto GJ, Braga GP, et al. Relationship between dysphagia, National Institutes of Health Stroke Scale Score, and predictors of pneumonia after ischemic stroke. J Stroke Cerebrovasc Dis. 2015;24(9):2088–94. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.05.009.CrossRefPubMedGoogle Scholar
- 8.Osawa A, Maeshima S, Tanahashi N. Efficacy of cilostazol in preventing aspiration pneumonia in acute cerebral infarction. J Stroke Cerebrovasc Dis. 2013;22(6):857–61. https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.06.008.CrossRefPubMedGoogle Scholar
- 9.Rowat A. Enteral tube feeding for dysphagic stroke patients. Br J Nurs. 2015;24(3):138, 140, 142–145. https://doi.org/10.12968/bjon.2015.24.3.138.
- 12.Yu Y, Zhu C, Liu C, Gao Y. Effect of prior atorvastatin treatment on the frequency of hospital acquired pneumonia and evolution of biomarkers in patients with acute ischemic stroke: a multicenter prospective study. Biomed Res Int. 2017;2017:5642704. https://doi.org/10.1155/2017/5642704.PubMedPubMedCentralCrossRefGoogle Scholar
- 18.Toyoda K, Arihiro S, Toda K, Yamagami H, Kimura K, Furui E, et al. Trends in oral anticoagulant choice for acute stroke patients with nonvalvular atrial fibrillation in Japan: the SAMURAI-NVAF study. Int J Stroke. 2015;10(6):836–42. https://doi.org/10.1111/ijs.12452.CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Nezu T, Koga M, Nakagawa J, Shiokawa Y, Yamagami H, Furui E, et al. Early ischemic change on CT versus diffusion-weighted imaging for patients with stroke receiving intravenous recombinant tissue-type plasminogen activator therapy: stroke acute management with urgent risk-factor assessment and improvement (SAMURAI) rt-PA registry. Stroke. 2011;42(8):2196–200. https://doi.org/10.1161/STROKEAHA.111.614404.CrossRefPubMedGoogle Scholar
- 22.Kalra L, Irshad S, Hodsoll J, Simpson M, Gulliford M, Smithard D, Patel A, Rebollo-Mesa I, STROKE-INF Investigators. Prophylactic antibiotics after acute stroke for reducing pneumonia in patients with dysphagia (STROKE-INF): a prospective, cluster-randomised, open-label, masked endpoint, controlled clinical trial. Lancet. 2015. https://doi.org/10.1016/s0140-6736(15)00126-9.CrossRefPubMedGoogle Scholar
- 26.Shinohara Y, Katayama Y, Uchiyama S, Yamaguchi T, Handa S, Matsuoka K, et al. Cilostazol for prevention of secondary stroke (CSPS 2): an aspirin-controlled, double-blind, randomised non-inferiority trial. Lancet Neurol. 2010;9(10):959–68. https://doi.org/10.1016/S1474-4422(10)70198-8.CrossRefPubMedGoogle Scholar
- 27.Arihiro S, Todo K, Koga M, Furui E, Kinoshita N, Kimura K, et al. Three-month risk-benefit profile of anticoagulation after stroke with atrial fibrillation: the SAMURAI-Nonvalvular Atrial Fibrillation (NVAF) study. Int J Stroke. 2016;11(5):565–74. https://doi.org/10.1177/1747493016632239.CrossRefPubMedGoogle Scholar
- 30.Smith CJ, Bray BD, Hoffman A, Meisel A, Heuschmann PU, Wolfe CD, et al. Can a novel clinical risk score improve pneumonia prediction in acute stroke care? A UK multicenter cohort study. J Am Heart Assoc. 2015;4(1):e001307. https://doi.org/10.1161/JAHA.114.001307.CrossRefPubMedPubMedCentralGoogle Scholar