Key result
Cilostazol-based dual antiplatelet therapy significantly reduced the risk of ischemic stroke recurrence (RR 0.54) compared to single antiplatelet therapy in East Asian patients.
Why the study?
The study aimed to systematically review the efficacy and safety of cilostazol-based dual antiplatelet therapy in patients with stroke.
Does cilostazol-based DAPT reduce stroke recurrence compared to monotherapy in East Asian patients with stroke?
Systematic Review (n=4,473)
Does cilostazol-based DAPT reduce stroke recurrence compared to monotherapy in East Asian patients with stroke?
Relative Risk: 0.54 (95% CI 0.38–0.75)
p-value: p=0.0003
Cilostazol-based DAPT is superior to aspirin or clopidogrel alone for long-term (>3 months) stroke prophylaxis in East Asian patients, without increasing the risk of serious adverse events.
Supports long-term use of cilostazol-based dual antiplatelet therapy for secondary stroke prevention.
Background and purpose: The objective of this study is to systematically review the efficacy and safety of cilostazol-based dual antiplatelet therapy (DAPT) in patients with stroke. Methods: Two reviewers conducted a comprehensive search of eligible studies published in PubMed, Medline, the Cochrane Library, Embase, and four Chinese databases from their establishment to 31 July 2024. The review was registered (CRD42024559047). Results: = 0.01). Furthermore, the incidence of general adverse events was higher in the cilostazol-based DAPT (RR = 1.93, 95% CI 1.16-3.21, P = 0.01), while no statistically significant difference was observed between the two groups with regard to serious adverse events. The subgroup analysis of follow-up time revealed that the cilostazol-based DAPT regimen demonstrated superior efficacy in reducing the incidence of ischemic stroke recurrence (RR = 0.51; 95% CI 0.36-0.73; P = 0.0002) and any stroke recurrence (RR = 0.49; 95% CI 0.35-0.67; P < 0.0001) in the long-term (>3 months) versus the short-term (≤3 months) group. Furthermore, the cilostazol-based DAPT regimen did not increase the risk of serious adverse events. Conclusion: DAPT combined with cilostazol and aspirin or clopidogrel was superior to aspirin or clopidogrel alone, did not increase serious adverse events, and was more effective for long-term (>3 months) prophylaxis. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024559047.
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Wang et al. (2025) conducted a systematic review in Ischemic stroke or transient ischemic attack (n=4,473). Cilostazol-based dual antiplatelet therapy vs. Single antiplatelet therapy (aspirin or clopidogrel) was evaluated on Ischemic stroke recurrence (RR 0.54, 95% CI 0.38-0.75, p=0.0003). Cilostazol-based dual antiplatelet therapy significantly reduced the risk of ischemic stroke recurrence (RR 0.54) compared to single antiplatelet therapy in East Asian patients.
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