Background and Purpose?We performed a systematic review and meta-analysis to explore the efficacy and safety ofcilostazol as a mono or combination (plus aspirin or clopidogrel) treatments compared to conventional single antiplatelettherapy (SAPT, mainly aspirin) for secondary stroke prevention.Methods?Randomized controlled trial studies were searched across multiple comprehensive databases (MEDLINE,EMBASE, and Cochrane) for review. The primary outcome was recurrent stroke comprising ischemic and hemorrhagicstroke. Secondary outcomes included ischemic stroke, hemorrhagic stroke, myocardial infarction, and compositeoutcomes. We performed an updated systematic review and meta-analysis of the identified reports, including 2 recentlypublished randomized controlled trials. In addition, network meta-analysis was performed to compare the relative effectsof mono versus combination cilostazol treatments.Results?Ten studies were included in this review, 5 of which were assigned to the cilostazol mono group (n=5429) andthe other 5 to the combination group (n=2456). The relative risks of recurrent stroke, ischemic stroke, and compositeoutcomes with cilostazol mono as well as combination treatments were significantly lower than with SAPT without anysignificant heterogeneity. An indirect comparison of these 3 outcomes revealed the cilostazol combination approach to besuperior. The cilostazol mono treatment diminished hemorrhagic stroke more significantly than SAPT and the cilostazolcombination did not increase hemorrhagic stroke compared to SAPT. The outcomes from the 2 cilostazol regimens werecomparable to SAPT in the case of myocardial infarction.Conclusions?Cilostazol is a more effective and safer treatment option than SAPT approaches using mainly aspirin.Cilostazol regimens can also be modified to clinical situations as this drug reduces recurrent and ischemic strokemore efficiently as a combination therapy but is more beneficial for hemorrhagic stroke as a monotherapy.
- Systematic review
ASJC Scopus subject areas
- Clinical Neurology
- Cardiology and Cardiovascular Medicine
- Advanced and Specialised Nursing