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

作　　者：Choon Han Tan Andrew GR Wu Ching-Hui Sia Aloysius ST Leow Bernard PL Chan Vijay Kumar Sharma Leonard LL Yeo Benjamin YQ Tan 

机构地区：[1]Department of Medicine,Lee Kong Chian School of Medicine,Nanyang Technological University,Singapore [2]Department of Medicine,Yong Loo Lin School of Medicine,National University of Singapore,Singapore [3]Department of Cardiology,National University Heart Centre,Singapore [4]Division of Neurology,Department of Medicine,National University Health System,Singapore

出　　处：《Stroke & Vascular Neurology》2021年第3期410-423,I0035-I0053,共33页卒中与血管神经病学（英文）

摘　　要：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 11429 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.

关 键 词：PREVENTION CILOSTAZOL REGIMEN 

分 类 号：R743.3[医药卫生—神经病学与精神病学]