Cilostazol administration for subarachnoid hemorrhage: A meta-analysis of randomized controlled trials

Update on Cilostazol: A Critical Review of Its Antithrombotic and Cardiovascular Actions and Its Clinical Applications

“…A meta‐analysis of 4 RCTs (n = 405) evaluating the effect of cilostazol in the treatment of subarachnoid hemorrhage showed that compared with control group, cilostazol can significantly reduce symptomatic vasospasm (OR, 0.35; P = .0001) and cerebral infarction (OR, 0.40; P = .003), and improve mild but not severe angiographic vasospasm (OR, 2.01; P = .01) and modified Rankin scale score ≤2 (OR, 2.70; P = .03) 246 . Adverse events, hemorrhagic events (OR, 0.62; P = .69) and cardiac events (OR, 2.14; P = .34) were not increased with cilostazol.…”

Fine tuning of neurointensive care in aneurysmal subarachnoid hemorrhage: From one-size-fits-all towards individualized care

“…Second, endothelin-receptor antagonists have proven to counteract cerebral vasospasm, but without any benefit on clinical outcome, possibly as a consequence of associated adverse effects such as anemia, arterial hypotension, and respiratory failure. 138 Third, other agents with a potential beneficial effect on cerebral vasospasm and DCI include statins 139 , 140 and magnesium sulphate, 141 which, so far, are promising but need further validation. 3 , 4 Fourth, mitochondrial dysfunction is common after aSAH 67 and as outlined above, cyclosporin has been used to treat this condition in TBI, 135 but it remains to be tested in aSAH.…”

“…Fifth, there are several emerging agents such as cilostazol that may exert broad-spectrum beneficial neuroprotective effects that need to be further explored in future randomized controlled trials. 140 Sixth, although tranexamic acid is not directly neuroprotective, it could be viewed as that in one sense, since administration after ictus until aneurysm occlusion may reduce the rate of re-bleedings and thereby secondary brain injury. However, concerns have also been raised regarding increased risk of thromboembolic complications with this treatment 136 , 142 , 143 and with modern management including early aneurysm occlusion it does not seem to add any benefit on long-term outcome.…”