Cilostazol for secondary stroke prevention: systematic review and meta-analysis

Tan, Choon Han; Wu, Anhua; Sia, Ching‐Hui; Leow, Aloysius Sheng‐Ting; Chan, Bernard P.L.; Sharma, Vijay K.; Yeo, Leonard L.L.; Tan, Benjamin Yq

doi:10.1136/svn-2020-000737

Cited by 17 publications

(26 citation statements)

References 46 publications

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Section: Discussionsupporting

confidence: 90%

“…For example, in previous clinical trials and meta-analyses, cilostazol significantly reduced the risk of stroke recurrence and lower bleeding events compared to aspirin (40,41). Moreover, our current meta-analysis is in line with previous meta-analyses that found cilostazol to be more beneficial in patients with ischemic stroke (18,42). Although current meta-analysis and previous studies have shown the effectiveness and relative safety of using cilostazol as secondary prevention of stroke, research also shows that, even in non-Asian populations, cilostazol may have a significant potential for secondary stroke prevention.…”

Section: Discussionsupporting

confidence: 88%

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The Efficacy and Safety of Cilostazol vs. Aspirin for Secondary Stroke Prevention: A Systematic Review and Meta-Analysis

Chai

Chen

et al. 2022

Front. Neurol.

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BackgroundCilostazol is often used in Asia-Pacific countries for stroke prevention. The current systematic review and meta-analysis aimed to evaluate the effectiveness, safety, and adverse outcomes of cilostazol monotherapy compared to aspirin monotherapy for secondary stroke prevention.MethodsThe researchers conducted a comprehensive research in multiple databases (PubMed, Embase, and Cochrane library) of randomized controlled trials from conception to December 2020. The primary efficacy outcome was the occurrence of any stroke, the primary safety outcome was the bleeding risk, and the primary adverse outcome was the rate of headache and dizziness. The Mantel-Haenszel method was used to calculate a random-effects prediction. Cilostazol and aspirin were compared using a pooled risk assessment with 95% CIs.ResultsSix studies involving 5,617 patients were included in this review. Compared with aspirin monotherapy, cilostazol was associated with significantly lower rates of any strokes (RR: 0.67; 95% CI: 0.55–0.82) and significantly lower bleeding rates [risk ratio (RR): 0.53; 95% CI: 0.37–0.74]. However, compared with aspirin monotherapy, cilostazol was associated with significantly higher rates of headache (RR: 1.77; 95% CI: 1.41–2.20) and dizziness (RR: 1.28; 95% CI: 1.08–1.52).ConclusionsConsistent with previous studies, cilostazol monotherapy is superior to aspirin monotherapy in reducing the rate of any strokes and the bleeding risk after having a stroke. However, the use of cilostazol monotherapy is associated with several adverse life outcomes such as headaches and dizziness.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 88%

The Efficacy and Safety of Cilostazol vs. Aspirin for Secondary Stroke Prevention: A Systematic Review and Meta-Analysis

Chai

Chen

et al. 2022

Front. Neurol.

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“…Another meta‐analysis indicated that cilostazol significantly decreased ischemic stroke (RR, 0.69) or any stroke recurrence (RR, 0.64) and MACEs (RR, 0.67) 10 . Cilostazol did not affect mortality (RR, 0.90) or the rate of good functional outcome.…”

Section: Strokementioning

confidence: 99%

“…A recent meta‐analysis of 18 RCTs (N = 11 429) showed that cilostazol demonstrated a favorable safety profile, significantly decreasing the risk of intracranial hemorrhage (relative risk [RR], 0.46) and major hemorrhagic events (RR, 0.49), vs conventional antiplatelet therapies such as aspirin and clopidogrel 10 …”

Section: Cardiovascular Effectsmentioning

confidence: 99%

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

Manolis

Manolis²,

Melita

et al. 2021

The Journal of Clinical Pharma

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Cilostazol, a phosphodiesterase III inhibitor, has vasodilating and antiplatelet properties with a low rate of bleeding complications. It has been used over the past 25 years for improving intermittent claudication in patients with peripheral artery disease (PAD). Cilostazol also has demonstrated efficacy in patients undergoing percutaneous revascularization procedures for both PAD and coronary artery disease. In addition to its antithrombotic and vasodilating actions, cilostazol also inhibits vascular smooth muscle cell proliferation via phosphodiesterase III inhibition, thus mitigating restenosis. Accumulated evidence has shown that cilostazol, due to its "pleiotropic" effects, is a useful, albeit underutilized, agent for both coronary artery disease and PAD. It is also potentially useful after ischemic stroke and is an alternative in those who are allergic or intolerant to classical antithrombotic agents (eg, aspirin or clopidogrel). These issues are herein reviewed together with the pharmacology and pharmacodynamics of cilostazol. Large studies and meta-analyses are presented and evaluated. Current guidelines are also discussed, and the spectrum of cilostazol's actions and therapeutic applications are illustrated.

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“…In addition, cilostazol may prevent recurrent ischemic stroke by improving endothelial function [ 44 ]. Cilostazol has been the focus of at least 18 randomized trials of secondary stroke prevention as outlined in a meta-analysis by Tan et al [ 45 ]. The dosing was typically 100 mg twice a day with or without aspirin.…”

Section: Cilostazolmentioning

confidence: 99%

Antithrombotic Therapy in the Prevention of Stroke

Bir

Kelley

2021

Biomedicines

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Overview: Ischemic stroke is a leading cause of death and disability throughout the world. Antithrombotic therapy, which includes both antiplatelet and anticoagulant agents, is a primary medication of choice for the secondary prevention of stroke. However, the choices vary with the need to incorporate evolving, newer information into the clinical scenario. There is also the need to factor in co-morbid medical conditions as well as the cost ramifications for a particular patient as well as compliance with the regimen. Pertinent Updates: In the acute setting, dual antiplatelet therapy from three weeks to up to three months has become recognized as a reasonable approach for patients with either minor stroke or transient ischemic attack or those with symptoms associated with higher-grade intracranial stenosis. This approach is favored for non-cardioembolic stroke as a cardiogenic mechanism tends to be best managed with attention to the cardiac condition as well as anticoagulant therapy. Risk stratification for recurrent stroke is important in weighing potential risk versus benefits. For example, prolonged dual antiplatelet therapy, with a combination such as aspirin and clopidogrel or aspirin and ticagrelor, tends to have negation of the potential clinical benefit of stroke prevention, over time, by the enhanced bleeding risk. Anticoagulant choices are now impacted by newer agents, initially identified as novel oral anticoagulants (NOACs), which also became associated with “non-vitamin K” agents as they are no longer considered novel. Alternatively, they are now often identified as direct oral anticoagulants (DOACs). They tend to be viewed as superior or non-inferior to warfarin with the caveat that warfarin is still viewed as the agent of choice for stroke prevention in patients with mechanical heart valves. Conclusion: Based upon cumulative information from multiple clinical trials of secondary prevention of stroke, there is an increasing array of approaches in an effort to provide optimal management. Antithrombotic therapy, including in combination with anticoagulant therapy, continues to evolve with the general caveat that “one size does not fit all”. In view of this, we desire to provide an evidence-based approach for the prevention of stroke with antithrombotic agents.

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Cilostazol for secondary stroke prevention: systematic review and meta-analysis

Cited by 17 publications

References 46 publications

The Efficacy and Safety of Cilostazol vs. Aspirin for Secondary Stroke Prevention: A Systematic Review and Meta-Analysis

The Efficacy and Safety of Cilostazol vs. Aspirin for Secondary Stroke Prevention: A Systematic Review and Meta-Analysis

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

Antithrombotic Therapy in the Prevention of Stroke

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