title: Meta-analysis of cilostazol versus aspirin for the secondary prevention of stroke.
abstract: Aspirin is the most widely prescribed antiplatelet agent for the secondary prevention of stroke. Cilostazol, an antiplatelet and vasodilating agent, has shown promise for the secondary prevention of stroke. A systematic review and meta-analysis of randomized controlled trials using Ovid MEDLINE, PubMed, and Excerpta Medica (EMBASE) was searched up to October 2012. Four trials, in 3,917 patients, comparing cilostazol with aspirin were identified. Compared with aspirin, cilostazol was associated with a 73% reduction in hemorrhagic stroke (relative risk [RR] 0.27, 95% confidence interval [CI] 0.13 to 0.54, p = 0.0002), 28% reduction in the composite end point of stroke, myocardial infarction, or vascular death (RR 0.72, 95% CI 0.57 to 0.89, p = 0.003), and 48% reduction in total hemorrhagic events (RR 0.52, 95% CI 0.34 to 0.79, p = 0.002), with trend for lesser gastrointestinal bleeds (RR 0.60, 95% CI 0.34 to 1.06, p = 0.08). In conclusion, compared with aspirin, cilostazol is associated with significantly less hemorrhagic stroke, the combined end point of stroke, myocardial infarction, and vascular death, and total hemorrhagic events, with numerically fewer gastrointestinal bleeds when used for the secondary prevention of stroke.
authors.affiliation: Wegmans Pharmacy, Ithaca, New York. Electronic address: jjdinicol@gmail.com.
authors.forename: James J
authors.initials: JJ
authors.lastname: Dinicolantonio
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Lavie
authors.forename: Hassan
authors.initials: H
authors.lastname: Fares
authors.forename: Arthur R
authors.initials: AR
authors.lastname: Menezes
authors.forename: James H
authors.initials: JH
authors.lastname: O'Keefe
authors.forename: Sripal
authors.initials: S
authors.lastname: Bangalore
authors.forename: Franz H
authors.initials: FH
authors.lastname: Messerli
mesh_terms: D001241:Aspirin / Q000627:therapeutic use*; D000077407:Cilostazol; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D055502:Secondary Prevention; D020521:Stroke / Q000517:prevention & control*; D013777:Tetrazoles / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D014665:Vasodilator Agents; D000077407:Cilostazol; D001241:Aspirin