The efficacy and safety of cilostazol for the secondary prevention of ischemic stroke in acute and chronic phases in Asian population- an updated meta-analysisReport as inadecuate




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 - Download this document for free, or read online. Document in PDF available to download.

BMC Neurology

, 14:251

Cerebrovascular disease and stroke

Abstract

BackgroundsWhile previous meta-analysis have investigated the efficacy of cilostazol in the secondary prevention of ischemic stroke, they were criticized for their methodology, which confused the acute and chronic phases of stroke. We present a new systematic review, which differs from previous meta-analysis by distinguishing between the different phases of stroke, and includes two new randomized, controlled trials RCTs.

MethodsAll 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 subarachnoid hemorrhage 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.

Results5491 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, cilostazol did not show any effect in the ROCI, HSSH, ACD and mRS compared to placebo or aspirin. The quality of the evidence from chronic phase was high or moderate, and those from acute phase were moderate or low when analyzed by GRADE approach.

ConclusionCilostazol provided a protective effect in the secondary prevention of the chronic phase of ischemic stroke.

KeywordsAcute Phase Chronic phase Cilostazol Meta-analysis Stroke Electronic supplementary materialThe online version of this article doi:10.1186-s12883-014-0251-7 contains supplementary material, which is available to authorized users.

LiGen Shi, JiaLi Pu contributed equally to this work.

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Author: LiGen Shi - JiaLi Pu - Liang Xu - Jay Malaguit - Jianmin Zhang - Sheng Chen

Source: https://link.springer.com/



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