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

BACKGROUND: Stroke is one of the leading causes of death worldwide. Cilostazol, an antiplatelet and phosphodiesterase 3 inhibitor, has not been clearly established for ischaemic stroke use. We aim to determine the efficacy and safety of cilostazol for secondary stroke prevention. METHODS: MEDLINE, E...

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Autores principales: Tan, Choon Han, Wu, Andrew GR, Sia, Ching-Hui, Leow, Aloysius ST, Chan, Bernard PL, Sharma, Vijay Kumar, Yeo, Leonard LL, Tan, Benjamin YQ
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8485237/
https://www.ncbi.nlm.nih.gov/pubmed/33542092
http://dx.doi.org/10.1136/svn-2020-000737
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author Tan, Choon Han
Wu, Andrew GR
Sia, Ching-Hui
Leow, Aloysius ST
Chan, Bernard PL
Sharma, Vijay Kumar
Yeo, Leonard LL
Tan, Benjamin YQ
author_facet Tan, Choon Han
Wu, Andrew GR
Sia, Ching-Hui
Leow, Aloysius ST
Chan, Bernard PL
Sharma, Vijay Kumar
Yeo, Leonard LL
Tan, Benjamin YQ
author_sort Tan, Choon Han
collection PubMed
description BACKGROUND: Stroke is one of the leading causes of death worldwide. Cilostazol, an antiplatelet and phosphodiesterase 3 inhibitor, has not been clearly established for ischaemic stroke use. We aim to determine the efficacy and safety of cilostazol for secondary stroke prevention. METHODS: MEDLINE, EMBASE, Cochrane Library, Web of Science and ClinicalTrials.gov were searched from inception to 25 September 2020, for randomised trials comparing the efficacy and safety of cilostazol monotherapy or dual therapy with another antiplatelet regimen or placebo, in patients with ischaemic stroke. Version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2) was used to assess study quality. This meta-analysis was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS: Eighteen randomised trials comprising 11 429 participants were included in this meta-analysis. Most trials possessed low risk of bias and were of low heterogeneity. Cilostazol significantly reduced the rate of ischaemic stroke recurrence (risk ratio, RR=0.69, 95% CI 0.58 to 0.81), any stroke recurrence (RR=0.64, 95% CI 0.54 to 0.74) and major adverse cardiovascular events (RR=0.67, 95% CI 0.56 to 0.81). Cilostazol did not significantly decrease mortality (RR=0.90, 95% CI 0.64 to 1.25) or increase the rate of good functional outcome (Modified Rankin Scale score of 0–1; RR=1.07, 95% CI 0.95 to 1.19). Cilostazol demonstrated favourable safety profile, significantly reducing the risk of intracranial haemorrhage (RR=0.46, 95% CI 0.31 to 0.68) and major haemorrhagic events (RR=0.49, 95% CI 0.34 to 0.70). CONCLUSIONS: Cilostazol demonstrated superior efficacy and safety profiles compared with traditional antiplatelet regimens such as aspirin and clopidogrel for secondary stroke prevention but does not appear to affect functional outcomes. Future randomised trials can be conducted outside East Asia, or compare cilostazol with a wider range of antiplatelet agents.
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spelling pubmed-84852372021-10-08 Cilostazol for secondary stroke prevention: systematic review and meta-analysis Tan, Choon Han Wu, Andrew GR Sia, Ching-Hui Leow, Aloysius ST Chan, Bernard PL Sharma, Vijay Kumar Yeo, Leonard LL Tan, Benjamin YQ Stroke Vasc Neurol Original Research BACKGROUND: Stroke is one of the leading causes of death worldwide. Cilostazol, an antiplatelet and phosphodiesterase 3 inhibitor, has not been clearly established for ischaemic stroke use. We aim to determine the efficacy and safety of cilostazol for secondary stroke prevention. METHODS: MEDLINE, EMBASE, Cochrane Library, Web of Science and ClinicalTrials.gov were searched from inception to 25 September 2020, for randomised trials comparing the efficacy and safety of cilostazol monotherapy or dual therapy with another antiplatelet regimen or placebo, in patients with ischaemic stroke. Version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2) was used to assess study quality. This meta-analysis was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS: Eighteen randomised trials comprising 11 429 participants were included in this meta-analysis. Most trials possessed low risk of bias and were of low heterogeneity. Cilostazol significantly reduced the rate of ischaemic stroke recurrence (risk ratio, RR=0.69, 95% CI 0.58 to 0.81), any stroke recurrence (RR=0.64, 95% CI 0.54 to 0.74) and major adverse cardiovascular events (RR=0.67, 95% CI 0.56 to 0.81). Cilostazol did not significantly decrease mortality (RR=0.90, 95% CI 0.64 to 1.25) or increase the rate of good functional outcome (Modified Rankin Scale score of 0–1; RR=1.07, 95% CI 0.95 to 1.19). Cilostazol demonstrated favourable safety profile, significantly reducing the risk of intracranial haemorrhage (RR=0.46, 95% CI 0.31 to 0.68) and major haemorrhagic events (RR=0.49, 95% CI 0.34 to 0.70). CONCLUSIONS: Cilostazol demonstrated superior efficacy and safety profiles compared with traditional antiplatelet regimens such as aspirin and clopidogrel for secondary stroke prevention but does not appear to affect functional outcomes. Future randomised trials can be conducted outside East Asia, or compare cilostazol with a wider range of antiplatelet agents. BMJ Publishing Group 2021-02-04 /pmc/articles/PMC8485237/ /pubmed/33542092 http://dx.doi.org/10.1136/svn-2020-000737 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Tan, Choon Han
Wu, Andrew GR
Sia, Ching-Hui
Leow, Aloysius ST
Chan, Bernard PL
Sharma, Vijay Kumar
Yeo, Leonard LL
Tan, Benjamin YQ
Cilostazol for secondary stroke prevention: systematic review and meta-analysis
title Cilostazol for secondary stroke prevention: systematic review and meta-analysis
title_full Cilostazol for secondary stroke prevention: systematic review and meta-analysis
title_fullStr Cilostazol for secondary stroke prevention: systematic review and meta-analysis
title_full_unstemmed Cilostazol for secondary stroke prevention: systematic review and meta-analysis
title_short Cilostazol for secondary stroke prevention: systematic review and meta-analysis
title_sort cilostazol for secondary stroke prevention: systematic review and meta-analysis
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8485237/
https://www.ncbi.nlm.nih.gov/pubmed/33542092
http://dx.doi.org/10.1136/svn-2020-000737
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