Key result
In a meta-analysis of 7,885 patients, cilostazol mono and combination treatments significantly reduced the risk of recurrent stroke compared to single antiplatelet therapy.
Why the study?
The study was conducted to evaluate the efficacy and safety of cilostazol monotherapy or combination therapy compared with conventional single antiplatelet therapy for secondary stroke prevention.
Does cilostazol (mono or combination therapy) reduce recurrent stroke in patients requiring secondary stroke prevention compared to conventional single antiplatelet therapy?
Meta-Analysis (n=7,885)
Does cilostazol (mono or combination therapy) reduce recurrent stroke in patients requiring secondary stroke prevention compared to conventional single antiplatelet therapy?
Cilostazol, either as monotherapy or in combination with aspirin or clopidogrel, is more effective and safer than conventional single antiplatelet therapy for secondary stroke prevention.
Answers are grounded in this paper and cite their sources.
Supports cilostazol for secondary stroke prevention; extends prior trial data via meta-analysis.
Background and Purpose- We performed a systematic review and meta-analysis to explore the efficacy and safety of cilostazol as a mono or combination (plus aspirin or clopidogrel) treatments compared to conventional single antiplatelet therapy (SAPT, mainly aspirin) for secondary stroke prevention. Methods- Randomized controlled trial studies were searched across multiple comprehensive databases (MEDLINE, EMBASE, and Cochrane) for review. The primary outcome was recurrent stroke comprising ischemic and hemorrhagic stroke. Secondary outcomes included ischemic stroke, hemorrhagic stroke, myocardial infarction, and composite outcomes. We performed an updated systematic review and meta-analysis of the identified reports, including 2 recently published randomized controlled trials. In addition, network meta-analysis was performed to compare the relative effects of mono versus combination cilostazol treatments. Results- Ten studies were included in this review, 5 of which were assigned to the cilostazol mono group (n=5429) and the other 5 to the combination group (n=2456). The relative risks of recurrent stroke, ischemic stroke, and composite outcomes with cilostazol mono as well as combination treatments were significantly lower than with SAPT without any significant heterogeneity. An indirect comparison of these 3 outcomes revealed the cilostazol combination approach to be superior. The cilostazol mono treatment diminished hemorrhagic stroke more significantly than SAPT and the cilostazol combination did not increase hemorrhagic stroke compared to SAPT. The outcomes from the 2 cilostazol regimens were comparable to SAPT in the case of myocardial infarction. Conclusions- Cilostazol is a more effective and safer treatment option than SAPT approaches using mainly aspirin. Cilostazol regimens can also be modified to clinical situations as this drug reduces recurrent and ischemic stroke more efficiently as a combination therapy but is more beneficial for hemorrhagic stroke as a monotherapy.
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Kim et al. (2019) conducted a meta-analysis in Secondary stroke prevention (n=7,885). Cilostazol (mono or combination therapy) vs. Single antiplatelet therapy (mainly aspirin) was evaluated on Recurrent stroke comprising ischemic and hemorrhagic stroke. In a meta-analysis of 7,885 patients, cilostazol mono and combination treatments significantly reduced the risk of recurrent stroke compared to single antiplatelet therapy.
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