title: Antiplatelet Agents for the Secondary Prevention of Ischemic Stroke or Transient Ischemic Attack: A Network Meta-Analysis.
abstract: Stroke can cause high morbidity and mortality, and ischemic stroke (IS) and transient ischemic attack (TIA) patients have a high stroke recurrence rate. Antiplatelet agents are the standard therapy for these patients, but it is often difficult for clinicians to select the best therapy from among the multiple treatment options. We therefore performed a network meta-analysis to estimate the efficacy of antiplatelet agents for secondary prevention of recurrent stroke. We systematically searched 3 databases (PubMed, Embase, and Cochrane) for relevant studies published through August 2015. The primary end points of this meta-analysis were overall stroke, hemorrhagic stroke, and fatal stroke. A total of 30 trials were included in our network meta-analysis and abstracted data. Among the therapies evaluated in the included trials, the estimates for overall stroke and hemorrhagic stroke for cilostazol (Cilo) were significantly better than those for aspirin (odds ratio [OR] = .64, 95% credibility interval [CrI], .45-.91; OR = .23, 95% CrI, .08-.58). The estimate for fatal stroke was highest for Cilo plus aspirin combination therapy, followed by Cilo therapy. The results of our meta-analysis indicate that Cilo significantly improves overall stroke and hemorrhagic stroke in IS or TIA patients and reduces fatal stroke, but with low statistical significance. Our results also show that Cilo was significantly more efficient than other therapies in Asian patients; therefore, future trials should focus on Cilo treatment for secondary prevention of recurrent stroke in non-Asian patients.
authors: Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors: Wen
authors: W
authors: Wang
authors: Department of Ophthalmology, School of Medicine, Shandong University, Jinan, China.
authors: Lu
authors: L
authors: Zhang
authors: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
authors: Weiming
authors: W
authors: Liu
authors: Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.
authors: Qin
authors: Q
authors: Zhu
authors: Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.
authors: Qing
authors: Q
authors: Lan
authors: Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. Electronic address: zhaojz205@126.com.
authors: Jizong
authors: J
authors: Zhao
mesh_terms: D044466:Asian People; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000208:ethnology / Q000401:mortality / Q000517:prevention & control*; D000077407:Cilostazol; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000208:ethnology / Q000401:mortality / Q000517:prevention & control*; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D065840:Protective Factors; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D020521:Stroke / Q000000981:diagnostic imaging / Q000208:ethnology / Q000401:mortality / Q000517:prevention & control*; D013777:Tetrazoles / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077407:Cilostazol
keywords: Antiplatelet agents; cilostazol; ischemic stroke; meta-analysis; transient ischemic attack