title: Efficacy and Safety of Cilostazol Therapy in Ischemic Stroke: A Meta-analysis.
abstract: BACKGROUND
  Antiplatelet therapy is recommended for patients who have experienced ischemic stroke. We performed a meta-analysis to compare the efficacy and safety of cilostazol with other antiplatelet therapies in patients with ischemic stroke.
  
  
  METHODS
  PubMed, EMBASE, MEDLINE, and the Cochrane Library were searched for randomized controlled trials published in English from May 1999 to May 2013. Clinical outcomes were compared by pooled and meta-regression analyses.
  
  
  RESULTS
  Nine studies involving 6328 patients satisfied our inclusion criteria. Stroke recurrence (including hemorrhagic and ischemic) with cilostazol use was 5.3% (157) versus 8.3% (248) in control group (risk ratio .63 [.52-.76], 95% confidence interval [CI]). Poststroke intracranial hemorrhage was .5% (16) with cilostazol versus 1.6% (46) in control group (risk ratio .36 [.21-.63], 95% CI). Poststroke extracranial bleeding complications occurred in 2.4% (66) of the patients taking cilostazol versus 3.9% (108) in control group (risk ratio .62 [.46-.83], 95% CI). No significant difference in cerebrovascular events (nonfatal stroke, intracranial hemorrhage, and transient ischemic attack) was found between the cilostazol group (8.2%, 246) versus control group (12.0%, 360; risk ratio .71 [.50-1.01], 95% CI). In addition, the cilostazol therapy brought about a nonsignificant reduction of cardiac adverse events (heart failure, myocardial infarction, and angina pectoris) comparing with control groups, with 3.8% (99) of the cilostazol group versus 4.7% (123) of control group (risk ratio, .81 [.62-1.04], 95% CI).
  
  
  CONCLUSIONS
  Cilostazol, alone or in combination with aspirin, significantly reduces stroke recurrence, poststroke intracranial hemorrhage, and extracranial bleeding in patients with a prior ischemic stroke as compared with other antiplatelet therapies.
authors: Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University, Chongqing, China.
authors: Liang
authors: L
authors: Tan
authors: Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, California.
authors: Barnhart
authors: B
authors: Margaret
authors: Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, California.
authors: John H
authors: JH
authors: Zhang
authors: Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University, Chongqing, China.
authors: Rong
authors: R
authors: Hu
authors: Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University, Chongqing, China.
authors: Yi
authors: Y
authors: Yin
authors: Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University, Chongqing, China.
authors: Liu
authors: L
authors: Cao
authors: Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University, Chongqing, China. Electronic address: fenghua8888@vip.163.com.
authors: Hua
authors: H
authors: Feng
authors: Department of Health Statistics, College of Preventive Medicine, Third Military Medical University, Chongqing, China. Electronic address: zyqtmmu@163.com.
authors: Yanqi
authors: Y
authors: Zhang
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications; D000077407:Cilostazol; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D013777:Tetrazoles / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D013777:Tetrazoles; D000077407:Cilostazol
keywords: Ischemic stroke; antiplatelet therapy; cilostazol; hemorrhage; meta-analysis