Cilostazol may prevent recurrent stroke without bleeding risk, finds study
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
