Liang Tan1, Barnhart Margaret2, John H Zhang2, Rong Hu1, Yi Yin1, Liu Cao1, Hua Feng3, Yanqi Zhang4. 1. Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University, Chongqing, China. 2. Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, California. 3. Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University, Chongqing, China. Electronic address: fenghua8888@vip.163.com. 4. Department of Health Statistics, College of Preventive Medicine, Third Military Medical University, Chongqing, China. Electronic address: zyqtmmu@163.com.
Abstract
BACKGROUND: Antiplatelet therapy is recommended for patients who have experienced ischemic stroke. We performed a meta-analysis to compare the efficacy and safety of cilostazol with other antiplatelet therapies in patients with ischemic stroke. METHODS: PubMed, EMBASE, MEDLINE, and the Cochrane Library were searched for randomized controlled trials published in English from May 1999 to May 2013. Clinical outcomes were compared by pooled and meta-regression analyses. RESULTS: Nine studies involving 6328 patients satisfied our inclusion criteria. Stroke recurrence (including hemorrhagic and ischemic) with cilostazol use was 5.3% (157) versus 8.3% (248) in control group (risk ratio .63 [.52-.76], 95% confidence interval [CI]). Poststroke intracranial hemorrhage was .5% (16) with cilostazol versus 1.6% (46) in control group (risk ratio .36 [.21-.63], 95% CI). Poststroke extracranial bleeding complications occurred in 2.4% (66) of the patients taking cilostazol versus 3.9% (108) in control group (risk ratio .62 [.46-.83], 95% CI). No significant difference in cerebrovascular events (nonfatal stroke, intracranial hemorrhage, and transient ischemic attack) was found between the cilostazol group (8.2%, 246) versus control group (12.0%, 360; risk ratio .71 [.50-1.01], 95% CI). In addition, the cilostazol therapy brought about a nonsignificant reduction of cardiac adverse events (heart failure, myocardial infarction, and angina pectoris) comparing with control groups, with 3.8% (99) of the cilostazol group versus 4.7% (123) of control group (risk ratio, .81 [.62-1.04], 95% CI). CONCLUSIONS: Cilostazol, alone or in combination with aspirin, significantly reduces stroke recurrence, poststroke intracranial hemorrhage, and extracranial bleeding in patients with a prior ischemic stroke as compared with other antiplatelet therapies.
BACKGROUND: Antiplatelet therapy is recommended for patients who have experienced ischemic stroke. We performed a meta-analysis to compare the efficacy and safety of cilostazol with other antiplatelet therapies in patients with ischemic stroke. METHODS: PubMed, EMBASE, MEDLINE, and the Cochrane Library were searched for randomized controlled trials published in English from May 1999 to May 2013. Clinical outcomes were compared by pooled and meta-regression analyses. RESULTS: Nine studies involving 6328 patients satisfied our inclusion criteria. Stroke recurrence (including hemorrhagic and ischemic) with cilostazol use was 5.3% (157) versus 8.3% (248) in control group (risk ratio .63 [.52-.76], 95% confidence interval [CI]). Poststroke intracranial hemorrhage was .5% (16) with cilostazol versus 1.6% (46) in control group (risk ratio .36 [.21-.63], 95% CI). Poststroke extracranial bleeding complications occurred in 2.4% (66) of the patients taking cilostazol versus 3.9% (108) in control group (risk ratio .62 [.46-.83], 95% CI). No significant difference in cerebrovascular events (nonfatal stroke, intracranial hemorrhage, and transient ischemic attack) was found between the cilostazol group (8.2%, 246) versus control group (12.0%, 360; risk ratio .71 [.50-1.01], 95% CI). In addition, the cilostazol therapy brought about a nonsignificant reduction of cardiac adverse events (heart failure, myocardial infarction, and angina pectoris) comparing with control groups, with 3.8% (99) of the cilostazol group versus 4.7% (123) of control group (risk ratio, .81 [.62-1.04], 95% CI). CONCLUSIONS:Cilostazol, alone or in combination with aspirin, significantly reduces stroke recurrence, poststroke intracranial hemorrhage, and extracranial bleeding in patients with a prior ischemic stroke as compared with other antiplatelet therapies.
Authors: Min Hyung Lee; Sang Uk Kim; Dong Hoon Lee; Young Il Kim; Chul Bum Cho; Seung Ho Yang; Il Sup Kim; Jae Taek Hong; Jae Hoon Sung; Sang Won Lee Journal: J Cerebrovasc Endovasc Neurosurg Date: 2016-09-30
Authors: Caroline McHutchison; Gordon W Blair; Jason P Appleton; Francesca M Chappell; Fergus Doubal; Philip M Bath; Joanna M Wardlaw Journal: Stroke Date: 2020-07-10 Impact factor: 7.914
Authors: Gordon W Blair; Jason P Appleton; Katie Flaherty; Fergus Doubal; Nikola Sprigg; Richard Dooley; Carla Richardson; Iona Hamilton; Zhe Kang Law; Yulu Shi; Michael S Stringer; Michael J Thrippleton; Julia Boyd; Kirsten Shuler; Philip M Bath; Joanna M Wardlaw Journal: EClinicalMedicine Date: 2019-04-24