Cilostazol may prevent recurrent stroke without bleeding risk, finds study

Written By : Medha Baranwal |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2020-07-28T19:54:08+05:30 | Updated On 11 Oct 2023 4:25 PM IST

UK: The use of cilostazol may reduce the risk of recurrent stroke without increasing hemorrhage risk, suggests a recent study published in the journal Stroke.

Cilostazol is a phosphodiesterase 3' inhibitor that is used in Asia-Pacific countries for the prevention of stroke but is rarely used elsewhere. In addition to weak antiplatelet effects, it aids myelin repair and astrocyte-neuron energy transfer and stabilizes endothelium. These effects may be used for the prevention of small vessel disease progression.

Caroline McHutchison, University of Edinburgh, United Kingdom, and colleagues conducted a systematic review and meta-analysis of unconfounded randomized controlled trials of cilostazol to prevent stroke, cognitive decline, or radiological small vessel disease lesion progression. They calculated Peto odds ratios (ORs) and 95% CIs for recurrent ischemic, hemorrhagic stroke, death, adverse symptoms, with sensitivity analyses.

A total of 20 randomized trials were included (n=10 505), 18 in ischemic stroke (total n=10 449), and 2 in cognitive impairment (n=56); most were performed in Asia-Pacific countries.

Key findings of the study include:

Cilostazol decreased recurrent ischemic stroke (17 trials, n=10 225, OR=0.68), hemorrhagic stroke (16 trials, n=9736, OR=0.43), deaths (OR=0.64), systemic bleeding (n=8387), but increased headache and palpitations, compared with placebo, aspirin, or clopidogrel.
Cilostazol reduced recurrent ischemic stroke more when given long (>6 months) versus short term without increasing hemorrhage, and in trials with larger proportions (>40%) of lacunar stroke.
Data were insufficient to assess effects on cognition, imaging, functional outcomes, or tolerance.

"Cilostazol appears effective for long-term secondary stroke prevention without increasing hemorrhage risk. However, most trials related to Asia-Pacific patients and more trials in Western countries should assess its effects on cognitive decline, functional outcome, and tolerance, particularly in lacunar stroke and other presentations of small vessel disease," concluded the authors.

The study, "Cilostazol for Secondary Prevention of Stroke and Cognitive Decline: Systematic Review and Meta-Analysis, is published in the journal Stroke.

DOI: https://doi.org/10.1161/STROKEAHA.120.029454

cilostazoljournal Strokestroke

Source : journal Stroke

Medha Baranwal

MSc. Biotechnology

Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751