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Preventing a second stroke is just as critical as surviving the first. Cilostazol, a phosphodiesterase III inhibitor, has emerged as a valuable alternative to aspirin, offering comparable efficacy with a potentially safer bleeding profile.
Cilostazol effectively lowers the risk of recurrent ischemic stroke and intracranial hemorrhage when compared to aspirin, with a trade-off of increased minor adverse effects.
Preventing a second stroke is just as critical as surviving the first. Cilostazol, a phosphodiesterase III inhibitor, has emerged as a valuable alternative to aspirin, offering comparable efficacy with a potentially safer bleeding profile. This meta-analysis explored how cilostazol stacks up against aspirin in secondary stroke prevention—providing insight into safer, patient-tailored antiplatelet strategies.
An extensive literature review was carried out across Web of Science, PubMed, EMBASE, and Cochrane Library, identifying randomized controlled trials examining cilostazol and aspirin for secondary ischemic stroke prophylaxis. Key endpoints encompassed recurrent ischemic stroke, intracranial hemorrhage (ICH), overall mortality, therapeutic response rate, and adverse event incidence. A random-effects meta-analysis was employed, with heterogeneity assessed via I² and Cochran’s Q. Using Doi plots and the Luis Furuya-Kanamori index, publication bias was examined.
In total, 13 trials involving 8,993 volunteers were analyzed. Cilostazol showed a clear advantage in minimizing the risk of recurrent ischemic stroke (risk ratio: 0.766) and ICH (risk ratio: 0.392) as opposed to aspirin. Mortality and overall adverse event rates did not differ markedly between groups. However, cilostazol was linked with a higher incidence of headache, dizziness, diarrhea, and tachycardia—but a lower risk of constipation. Study heterogeneity was low-to-moderate.
Cilostazol offers a compelling alternative to aspirin for preventing secondary strokes, especially for those at heightened risk of bleeding. While not free from side effects, its favorable risk-benefit profile may make it the better fit for selected patients. Personalized therapy remains key, and ongoing research will be fundamental in defining cilostazol’s optimal role in clinical care.
Internal Medicine Journal
Efficacy and safety of using cilostazol versus aspirin in secondary stroke prevention: systematic review and meta-analysis of randomised controlled clinical trials
Ping Zhuang et al.
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