Cilostazol for Preventing Ischemic Stroke Recurrence: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YAN Qi ^1,2 ,  SHI Zhenghong ² , YANG Kehu ¹ , TIAN Jinhui ¹

1. Evidence-Based Medicine Center of Lanzhou University, Lanzhou 730000, China;2. The Second Hospital of Lanzhou University, Lanzhou 730030, China;

Corresponding author：

SHI Zhenghong, Email: shizhenghong20022002@yahoo.com.cn

Keywords：

Cilostazol; Aspirin; Ischemic stroke; Meta-analysis; Systematic review

DOI：

10.7507/1672-2531.20110096

Video：

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Objective 　To systematically assess the clinical efficacy and safety of cilostazol for preventing ischemic stroke recurrence.
Methods 　Such databases as PubMed, The Cochrane Library, EMbase, CNKI, CBM, and VIP were searched for randomized controlled trials (RCTs) on the use of cilostazol to prevent ischemic stroke recurrence (up to November, 2010). Two researchers selected studies and extracted data independently using a designed extraction form. The quality of included trials was evaluated and RevMan 5.0 software was used for meta-analyses.
Results 　Four RCTs involving 3 916 patients were included. The results of meta-analyses showed that there were significant differences between cilostazol and aspirin in terms of hemorrhagic stroke occurrence (RR=0.39, 95%CI 0.24 to 0.61, P lt;0.000 1), headache occurrence (RR=1.99, 95%CI 1.16 to 3.43, P=0.01) and dizziness occurrence (RR=1.43, 95%CI 1.13 to 1.79, P=0.002). Whereas, no significant difference was found between the two groups in terms of ischemic stroke recurrence (RR=0.80, 95%CI 0.61 to 1.04, P=0.10) and transient ischemic attack occurrence (RR=0.93, 95%CI 0.45 to 1.92, P=0.85).
Conclusion 　The current evidence indicates that cilostazol is as effective as aspirin in preventing ischemic stroke recurrence, but with less incidence of hemorrhagic stroke.

Citation： YAN Qi,SHI Zhenghong,YANG Kehu,TIAN Jinhui. Cilostazol for Preventing Ischemic Stroke Recurrence: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2011, 11(5): 540-544. doi: 10.7507/1672-2531.20110096 Copy

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2.	Feigin VL. Stroke epidemiology in the developing world. Lancet , 2005, 365(9478): 2160-2161.
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9.	刘鸣. 缺血性卒中的抗血小板治疗. 国外医学#脑血管疾病分册, 2005, 13(4): 274-277.
10.	Ikeda Y. Antiplatelet therapy using cilostazol a specific PDE3 inhibitor. J Thromb Haemost , 1999, 82(2): 435-438.
11.	Matsumoto M. Cilostazol in secondary prevention of stroke: impact of the Cilostazol Stroke Prevention Study. Atheroscler Suppl , 2005, 6(4): 33-40.
12.	Huang Y, Cheng Y, Wu J, et al . Cilostazol as an alternative to aspirin after ischaemic stroke: a randomised, doubleblind, pilot study. Lancet Neurol , 2008, 7(6): 494-499.
13.	Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. [www.cochrane-handbook.org/]. Accessed 10 March 2009.
14.	Lee YS, Bae HJ, Lee SH, et al . Cilostazol in Acute Ischemic Stroke Treatment (CAIST). Final results. Cerebrovascular Diseases , 2009, 27(Suppl.6): 81.
15.	Guo JJ, Xu E, Lin QY, et al . Effect of cilostazol on cerebral arteries in secondary prevention of ischemic stroke. Neurosci Bull , 2009, 25(6): 383-390.
16.	Shinohara Y, Katayama Y, Uchiyama S, et al . Cilostazol for prevention of secondary stroke (CSPS 2): An aspirin-controlled, double-blind, randomised non-inferiority trial. Lancet Neurol , 2010, 9(10): 959-968.
17.	Sorkin EM, Markham A. Cilostazol. Drugs Aging , 1999, 14(1): 63.
18.	Gotoh F, Tohgi H, Hirai S, et al . Cilostazol stroke prevention study: A placebo-controlled double-blind trial for secondary prevention of cerebral infarction. J Stroke Cerebrovasc Dis , 2000, 9(4): 147-157.
19.	戢秋明. 脑卒中复发对患者生活质量的影响. 临床心身疾病杂志, 2007, 13(5): 398-399.

1. 1 Lopez AD, Mathers CD, Ezzati M, et al . Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet , 2006, 367(9524): 1747-1757.
2. Feigin VL. Stroke epidemiology in the developing world. Lancet , 2005, 365(9478): 2160-2161.
3. 中华医学会神经病学分会脑血管病组缺血性脑卒中二级预防指南撰写组. 中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2010. 中华神经科杂志, 2010, 43(2): 154-160.
4. 苏定冯. 从基础研究看脑卒中防治策略. 中华老年心脑血管病杂志, 2008, 10(2): 86.
5. Liu M, Wu B, Wang WZ, et al . Stroke in China: epidemiology, prevention, and management strategies. Lancet Neurol , 2007, 6(5): 456-464.
6. 柯闻. 我国脑卒中发生率和复发率全球最高. Available from: URL: http://health.ycwb. com/2008-11/25/content_2017575.htm.
7. 白毅. 构筑预防卒中复发的防线——专家强调他汀类药物对卒中二级预防的重要作用. 中国医药报, 2007, 102: B6.
8. 赵美英, 刘鸣. 他汀类药物预防脑卒中的高质量临床证据. 中国实用内科杂志, 2007, 27(4): 302-306.
9. 刘鸣. 缺血性卒中的抗血小板治疗. 国外医学#脑血管疾病分册, 2005, 13(4): 274-277.
10. Ikeda Y. Antiplatelet therapy using cilostazol a specific PDE3 inhibitor. J Thromb Haemost , 1999, 82(2): 435-438.
11. Matsumoto M. Cilostazol in secondary prevention of stroke: impact of the Cilostazol Stroke Prevention Study. Atheroscler Suppl , 2005, 6(4): 33-40.
12. Huang Y, Cheng Y, Wu J, et al . Cilostazol as an alternative to aspirin after ischaemic stroke: a randomised, doubleblind, pilot study. Lancet Neurol , 2008, 7(6): 494-499.
13. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. [www.cochrane-handbook.org/]. Accessed 10 March 2009.
14. Lee YS, Bae HJ, Lee SH, et al . Cilostazol in Acute Ischemic Stroke Treatment (CAIST). Final results. Cerebrovascular Diseases , 2009, 27(Suppl.6): 81.
15. Guo JJ, Xu E, Lin QY, et al . Effect of cilostazol on cerebral arteries in secondary prevention of ischemic stroke. Neurosci Bull , 2009, 25(6): 383-390.
16. Shinohara Y, Katayama Y, Uchiyama S, et al . Cilostazol for prevention of secondary stroke (CSPS 2): An aspirin-controlled, double-blind, randomised non-inferiority trial. Lancet Neurol , 2010, 9(10): 959-968.
17. Sorkin EM, Markham A. Cilostazol. Drugs Aging , 1999, 14(1): 63.
18. Gotoh F, Tohgi H, Hirai S, et al . Cilostazol stroke prevention study: A placebo-controlled double-blind trial for secondary prevention of cerebral infarction. J Stroke Cerebrovasc Dis , 2000, 9(4): 147-157.
19. 戢秋明. 脑卒中复发对患者生活质量的影响. 临床心身疾病杂志, 2007, 13(5): 398-399.

Chinese Journal of Evidence-Based Medicine

Cilostazol for Preventing Ischemic Stroke Recurrence: A Meta-analysis

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