11 Aug 20. Featured Paper
Cilostazol for secondary prevention of stroke & cognitive decline: systematic review & meta-analysis.
Background & purpose: Cilostazol, a phosphodiesterase 3’ inhibitor, is used in Asia-Pacific countries for stroke prevention, but rarely used elsewhere.
In addition to weak antiplatelet effects, it stabilizes endothelium, aids myelin repair & astrocyte-neuron energy transfer in laboratory models, effects that may be beneficial in preventing small vessel disease progression.
Two reviewers searched for papers (January 1, 2019 to July 16, 2019) & extracted data.
We calculated Peto odds ratios (ORs) & 95% CIs for recurrent ischemic, hemorrhagic stroke, death, adverse symptoms, with sensitivity analyses.
The review is registered (CRD42018084742).
Results: We included 20 randomized controlled trials (n=10 505), 18 in ischemic stroke (total n=10 449) & 2 in cognitive impairment (n=56); most were performed in Asia-Pacific countries.
Cilostazol decreased recurrent ischemic stroke (17 trials, n=10 225, OR=0.68 [95% CI, 0.57–0.81]; P<0.0001), hemorrhagic stroke (16 trials, n=9736, OR=0.43 [95% CI, 0.29–0.64]; P=0.0001), deaths (OR=0.64 [95% CI, 0.49–0.83], P<0.0009), systemic bleeding (n=8387, OR=0.73 [95% CI, 0.54–0.99]; P=0.04), but increased headache & palpitations, compared with placebo, aspirin, or clopidogrel.
Data were insufficient to assess effects on cognition, imaging, functional outcomes, or tolerance.
Conclusions: Cilostazol appears effective for long-term secondary stroke prevention without increasing hemorrhage risk.
However, most trials related to Asia-Pacific patients & more trials in Western countries should assess its effects on cognitive decline, functional outcome, & tolerance, particularly in lacunar stroke & other presentations of small vessel disease.
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Featured paper: Cilostazol for secondary prevention of stroke & cognitive decline: systematic review & meta-analysis. @StrokeAHA_ASA @EdinUniBrainSci #Stroke #Aspirin