The efficacy and safety of cilostazol for the secondary prevention of ischemic stroke in acute and chronic phases in Asian population- an updated meta-analysis (BMC Neurology)

BackgroundsWhile previous meta-analyseshaveinvestigated the efficacy of cilostazol in the secondary prevention of ischemic stroke, theywere criticized for their methodology, whichconfused the acute and chronic phases of stroke. We present a new systematic review, which differs from previous meta-analyses by distinguishing between the different phases of stroke, and includes two new randomized, controlled trials (RCTs). Methods: All RCTs investigating the effect of cilostazol on secondary prevention of ischemic stroke were obtained. Outcomes were analyzed by Review Manager, including recurrence of cerebral infarction (ROCI), hemorrhage stroke or subarachnoidhemorrhage (HSSH), all-cause death (ACD), and modified Rankin Scale score (mRS). The Grading of Recommendations Assessment,Development and Evaluation (GRADE) assessed the quality of the evidence. Results: 5491 patients from six studies were included in the current study. In secondary prevention of ischemic stroke in chronic phase, cilostazol was associated with a 47% reduction in ROCI(relative risk [RR] 0.53, 95% confidence interval [CI] 0.34 to 0.81, p?=?0.003), while no significant difference in HSSH and ACD compared with placebo;and 71% reduction in HSSH (RR 0.29, 95% CI 0.15 to 0.56, p?=?0.0002) compared with aspirin, but not in ROCI and ACD.In the secondary prevention of ischemic stroke in acute phase, cilostazoldid not showany effect in the ROCI, HSSH, ACD and mRScompared to placebo or aspirin. Thequality of the evidence from chronic phase was high or moderate, and those from acute phase were moderate or lowwhen analyzed by GRADE approach. Conclusion: Cilostazolprovided a protective effect in the secondary prevention of the chronic phase ofischemic stroke.