Pembukaan: Good morning/good afternoon.

Today i would like to present my first journal

presentation with the title Cilostazol for prevention of secondary stroke (CSPS 2):
an aspirin-controlled, double-blind, randomised non-inferiority trial.

As we know.. slide 2

Selesai slide 2: So many studies had been been developed to expose the antiplatelet role
in cerebrovascular disease and cardiovascular disese.

The most famous antiplatelet we had been known is platelet. It used worldwide as an anti
platelet aggragation. But Today we will learn about the efficacy of cilostazol as an
antiplatelet aggregation and its role to prevent the secondary stroke.

Slide 2

1.

2. it also has..

3.

4.

With the complex mechanism

Slide 4

The diagram shows us how cilostazol worked. This picture shows us the event that
happened in phospholipase and arachidonic acid cycle. So we see the aspirin will inhibit
the cyclooxygenase ezyme and will prevent the transformation arachidonic acid to
thromboxane A2. On the other side cilostazol inhibit phosphodiesterase 3 enzyme and it
will increase the concentration of cAMP. An increase in cAMP results in an increase in the
active form of protein kinase A (PKA), which is directly related with an inhibition in
platelet aggregation.

Beside those mechanism, Cilostazol also increases adenosine level, and has a positive
effect to prostaglandin and Nitrite oxyde. This mechanism explain why cilostazol has an
vasodilatory activity and protect the vascular or endothelium wall.
Slide 5

In this next picture im trying to compare the mechanism of cilostazol and aspirin.

Menjelaskan gambar.

Setelah Slide 6

So this study is the continuation of CSPS 1, but this research increase it level by comparing
cilostazol with aspirin, not with the placebo.

Akhir Slide 7

It means All patients, study personnel, investigators, and the sponsor didnt know who
received cilostazol or aspirin for the patients treatment.

Slide 9-1

Increased risk of hemorrhage means the patients had history of bleeding, or many disease
could cause any bleeding.

The randomisation table was generated with SAS (version 8.2) by the personnel responsible for drug
allocation from the contract research organisation and random allocation was done with a dynamic
balancing method with stratifi cation by age, sex, and study institution to minimise differences in the
distribution of baseline variables between the two groups.

Selesai Slide 10 (jelaskan tabel)

So this table shows us the patients between 2 groups are well balanced according to
demographic and clinical characteristic.
Sebelum Slide 11

How the patients receive their treatment?

Penutup Slide 12

So the purpose of this study are to describe how effective cilostazol prevent the incidence
of recurrent stroke compare with aspirin and to describe how safety cilostazol compare
with aspirin according to hemorrhage event that could be happened.

Penutup slide 13

This Secondary endpoints related to side effect that can be happened in during the
treatment.

Patients were assessed at baseline, week 12, and every 24 weeks thereafter until the end of the trial.
At each visit, haematological and biochemical laboratory analyses, blood pressure measurement,
and electrocardiography (ECG) were done. Study treatment was continued for a minimum of 1 year
and a

Selesai Slide 16

From this result we can see that cilostazol is significantly reduce the occurence of
recurrent stroke compare with aspirin with p value less than 0,05.

Penjelasan Tabel Slide 18

So in this table we can see the result of the study. For the primary endpoint, cilostazol
prove itself can reduce the risk of recurrent infarction than aspirin with the hazard ratio
less than 1.
We can also see the secondary endpoints and safety points give significant result for the
patients who had been taken cilostazol.

Setelah Slide 21

Cilostazol looked like won the battle for every aspect compared with aspirin, but it lose
for one criteria, the minor side effect. Headache, diarrhoea, palpitation, dizziness, and
tachycardia were more frequent in the cilostazol group than in the aspirin group