Cilostazol Versus Aspirin for Secondary Stroke Prevention: Systematic Review and Meta-Analysis

西洛他唑 阿司匹林 医学 荟萃分析 冲程(发动机) 内科学 随机对照试验 相对风险 血小板聚集抑制剂 置信区间 麻醉 心脏病学 机械工程 工程类
作者
Michelle Lin,James F. Meschia,Neethu Gopal,Kevin M. Barrett,Owen A. Ross,Nilüfer Ertekin‐Taner,Thomas G. Brott
出处
期刊:Journal of stroke and cerebrovascular diseases [Elsevier BV]
卷期号:30 (3): 105581-105581 被引量:12
标识
DOI:10.1016/j.jstrokecerebrovasdis.2020.105581
摘要

Objectives Cilostazol has promise as an alternative to aspirin for secondary stroke prevention given its vasodilatory and anti-inflammatory properties in addition to platelet aggregation inhibition. We aimed to conduct a systematic review and meta-analysis to estimate the efficacy and safety of cilostazol compared to aspirin for stroke prevention in patients with previous stroke or transient ischemic attack (TIA). Materials and methods We searched PubMed and the Cochrane Central Register of Controlled Trials from 1996 to 2019. Randomized clinical trials that compared cilostazol to aspirin and reported the endpoints of ischemic stroke, intracranial hemorrhage and any bleeding were included. A random-effects estimate was computed based on the Mantel-Haenszel method. The pooled risk estimates with 95% confidence intervals were compared between cilostazol and aspirin. Results The search identified 5 randomized clinical trials comparing cilostazol vs. aspirin for secondary stroke prevention that collectively enrolled 7240 patients, all from Asian countries (3615 received cilostazol and 3625 received aspirin). Pooled results from the random-effects model showed that cilostazol was associated with significantly lower risk of recurrent ischemic stroke (RR 0.68; 95% CI, 0.54 to 0.87), intracranial hemorrhage (RR 0.42; 95% CI, 0.27 to 0.65) and any bleeding (RR 0.71; 95% CI, 0.55 to 0.91). Conclusions This meta-analysis suggests that cilostazol is more effective than aspirin in preventing recurrent ischemic stroke with lower risk of intracranial hemorrhage and other bleeding. Since all trials to date are from Asian countries, confirmatory trials of cilostazol for secondary stroke prevention in other populations are needed.
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