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.

中文翻译：

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西洛他唑与阿司匹林对继发性卒中的预防：系统评价和荟萃分析

目标

西洛他唑由于具有血管舒张和抗炎特性，并具有抑制血小板聚集的作用，因此有望替代阿司匹林用于继发性卒中的预防。我们旨在进行系统的回顾和荟萃分析，以评估西洛他唑与阿司匹林相比在先前卒中或短暂性脑缺血发作（TIA）患者中预防卒中的有效性和安全性。

材料和方法

我们搜索了1996年至2019年的PubMed和对照试验的Cochrane中央登记册。比较了西洛他唑和阿司匹林的随机临床试验，并报告了缺血性中风，颅内出血和任何出血的终点。基于Mantel-Haenszel方法计算了随机效应估计。在西洛他唑和阿司匹林之间比较了具有95％置信区间的合并风险估计值。

结果

这项搜索确定了5项比较西洛他唑与阿司匹林用于预防中风的随机临床试验，该研究共招募了7240例患者，全部来自亚洲国家（3615例接受西洛他唑，3625例接受阿司匹林）。随机效应模型的汇总结果表明，西洛他唑与复发性缺血性卒中的风险显着降低（RR 0.68； 95％CI，0.54至0.87），颅内出血（RR 0.42； 95％CI，0.27至0.65）以及其他相关因素出血（RR 0.71; 95％CI，0.55至0.91）。

结论

这项荟萃分析表明，西洛他唑在预防复发性缺血性卒中方面比阿司匹林更有效，颅内出血和其他出血的风险较低。由于迄今为止所有试验均来自亚洲国家，因此需要西洛他唑在其他人群中预防继发性中风的确证试验。