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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...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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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. |
format | Online Article Text |
id | pubmed-8485237 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
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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