Efficacy and safety of using cilostazol versus aspirin in secondary stroke prevention: systematic review and meta-analysis of randomised controlled clinical trials

IF 1.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Internal Medicine Journal Pub Date : 2025-03-06 DOI:10.1111/imj.16657

Ping Zhuang, Yi-min Huang, Zhenyong Zheng, Xiaodie Zhang

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引用次数: 0

Abstract

Background

Secondary stroke prevention is crucial for reducing recurrent events and associated morbidity. Cilostazol, a phosphodiesterase III inhibitor, is considered an alternative to aspirin for patients with ischaemic stroke due to its potentially lower risk of haemorrhagic complications. This meta-analysis evaluates the efficacy and safety of cilostazol versus aspirin for secondary stroke prevention. It provides a basis for drug selection and observation of secondary stroke prevention strategies.

Methods

A comprehensive search was conducted in PubMed, Cochrane Library, EMBASE and Web of Science databases for randomised controlled trials comparing cilostazol with aspirin in secondary stroke prevention. Key outcomes included recurrence of ischaemic stroke, intracranial haemorrhage (ICH), death, effective rate and incidence of adverse events. Meta-analysis was performed using a random-effects model, and heterogeneity was assessed using I² statistics and Cochran's Q test. Publication bias was evaluated using Doi plots and Luis Furuya-Kanamori index.

Results

Thirteen studies involving 8993 participants were included. Cilostazol significantly reduced the recurrence of ischaemic stroke (risk ratio (RR): 0.766, 95% confidence interval (CI): 0.624–0.941) and ICH (RR: 0.392, 95% CI: 0.250–0.616) compared to aspirin. No significant differences were observed in overall mortality or adverse events. Cilostazol increased risks of headache, dizziness, diarrhoea and tachycardia but reduced constipation. Heterogeneity was generally low to moderate.

Conclusion

Cilostazol is an effective alternative to aspirin for secondary stroke prevention, reducing the risk of recurrent ischaemic stroke and ICH. However, its use is associated with certain adverse effects. Clinicians should consider individual patient profiles and preferences when selecting anti-platelet therapy for stroke prevention. Further research is warranted to optimise cilostazol use in clinical practice.

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背景：中风二级预防对于减少复发和相关发病率至关重要。西洛他唑是一种磷酸二酯酶 III 抑制剂，由于出血性并发症的潜在风险较低，被认为是缺血性中风患者服用阿司匹林的替代药物。本荟萃分析评估了西洛他唑与阿司匹林在中风二级预防方面的疗效和安全性。它为中风二级预防策略的药物选择和观察提供了依据：方法：在 PubMed、Cochrane Library、EMBASE 和 Web of Science 数据库中全面检索了在中风二级预防中比较西洛他唑与阿司匹林的随机对照试验。主要结果包括缺血性中风复发、颅内出血（ICH）、死亡、有效率和不良事件发生率。采用随机效应模型进行 Meta 分析，并使用 I2 统计量和 Cochran's Q 检验评估异质性。使用Doi图和Luis Furuya-Kanamori指数评估发表偏倚：结果：共纳入 13 项研究，涉及 8993 名参与者。西洛他唑能明显降低缺血性中风的复发率（风险比 (RR)：0.766，95% 置信度）：0.766，95% 置信区间 (CI)：0.624-0.941）和 ICH（RR：0.392，95% CI：0.250-0.616）。在总死亡率或不良事件方面未观察到明显差异。西洛他唑增加了头痛、头晕、腹泻和心动过速的风险，但减少了便秘。异质性一般为低度至中度：西洛他唑是阿司匹林二级预防中风的有效替代药物，可降低缺血性中风复发和 ICH 的风险。结论：西洛他唑可有效替代阿司匹林用于中风二级预防，降低缺血性中风复发和 ICH 的风险。临床医生在选择预防中风的抗血小板疗法时应考虑患者的个体情况和偏好。在临床实践中优化西洛他唑的使用还需要进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Internal Medicine Journal 医学-医学：内科

CiteScore

3.50

自引率

4.80%

发文量

600

审稿时长

3-6 weeks

期刊介绍： The Internal Medicine Journal is the official journal of the Adult Medicine Division of The Royal Australasian College of Physicians (RACP). Its purpose is to publish high-quality internationally competitive peer-reviewed original medical research, both laboratory and clinical, relating to the study and research of human disease. Papers will be considered from all areas of medical practice and science. The Journal also has a major role in continuing medical education and publishes review articles relevant to physician education.