title: 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.
abstract: BACKGROUND
  While 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).
  
  
  METHODS
  All 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.
  
  
  RESULTS
  5491 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.
  
  
  CONCLUSIONS
  Cilostazol provided a protective effect in the secondary prevention of the chronic phase of ischemic stroke.
authors.affiliation: Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China. slg0904@163.com.
authors.forename: LiGen
authors.initials: L
authors.lastname: Shi
authors.affiliation: Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China. carrie1105@gmail.com.
authors.forename: JiaLi
authors.initials: J
authors.lastname: Pu
authors.affiliation: Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China. maxalive@163.com.
authors.forename: Liang
authors.initials: L
authors.lastname: Xu
authors.affiliation: Department of Physiology and Pharmacology, Loma Linda University, Loma Linda, CA, USA. jmalaguit@llu.edu.
authors.forename: Jay
authors.initials: J
authors.lastname: Malaguit
authors.affiliation: Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China. zjm135vip@126.com.
authors.forename: Jianmin
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China. saintchan@sina.com.
authors.forename: Sheng
authors.initials: S
authors.lastname: Chen
mesh_terms: D000208:Acute Disease; D044466:Asian People; D001241:Aspirin / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D002544:Cerebral Infarction / Q000517:prevention & control*; D002908:Chronic Disease; D000077407:Cilostazol; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D055502:Secondary Prevention; D020521:Stroke / Q000517:prevention & control; D013345:Subarachnoid Hemorrhage / Q000139:chemically induced; D013777:Tetrazoles / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077407:Cilostazol; D001241:Aspirin