Abstract: Objective To compare the clinical effect and the prognosis of dual anti-platelet therapies between cilostazol plus aspirin and cilostazol plus ticagrelor in the elderly patients with acute cerebral infarction(ACI) combined with clopidogrel resistance. Methods A total of 90 elderly patients with ACI combined with clopidogrel resistance were enrolled and randomly divided into the aspirin group(dual anti-platelet therapy with cilostazol plus aspirin) and the ticagrelor group(dual anti-plaelet therapy with cilostazol plus ticagrelor). The serum levels of malondialdehyde(MDA) and superoxidase dismutase(SOD), the hemorheological indexes of plasma viscosity, whole blood viscosity at high shear rate, whole blood viscosity at low shear rate, fibrinogen(Fbg) and platelet aggregation rate(PAR), the coagulation indexes of prothrombin time(PT), international normalized ratio(INR), plateletⅡb/Ⅲa complex(CD61), platelet fibrinogen receptor(PAC-1) were compared between the two groups. The adverse reactions in both groups were recorded and compared as well. After 2 years of followed-up, the scores of Barthel indexes(BI), modified Rankin scale(mRS) and National Institute of Health Stroke Scale (NIHSS) and the incidence rate of end-point events were compared between the two groups. Results Compared to the aspirin group, the serum levels of MDA, the hemorheology indexes, CD61 and PAC-1 after therapy were lower and the level of SOD was higher in the ticagrelor group. The incidence rate of headache in the ticagrelor group was significantly higher than that in the aspirin group(P<0.05). After 2 years of followed-up, compared to the aspirin group, the incidence rate of the main and secondary end-point events were lower in the ticagrelor group(P<0.05). There were no significant differences in the scores of BI, mRS and NIHSS between the two groups(P>0.05). Conclusions The dual anti-platelet therapy with cilostazol plus ticagrelor can improve the effect and prognosis in the elderly patients with ACI combined with clopidogrel resistance.

Key words: cilostazol, ticagrelor, aspirin, acute cerebral infarction, clopidogrel resistance, prognosis