Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Eur J Med Res. 2013 Dec 6;18(1):53. doi: 10.1186/2047-783X-18-53.
To study the efficacy and safety of cilostazol on ischemic stroke prevention and treatment, systematic reviews of related clinical randomized controlled trials were analyzed.
We searched the main databases for eligible trials including literature from January 1966 to November 2012 in MEDLINE, reports from 1980 to November 2012 in EMBASE, and all the studies published in EBSCO, Springer, Ovid, and Cochrane library citations. We also searched for keywords, including cilostazol and aspirin. RewMan 5.0 software was used to conduct the meta-analysis.
Our search yielded five eligible trials. The effects of cilostazol and aspirin on ischemic stroke prevention and treatment were almost equal (combined odds ratio (OR) 0.78, 95% confidence interval (CI) (0.59, 1.04)). Additionally, both magnetic resonance angiography (MRA) and transcranial Doppler (TCD) examination showed that cilostazol could significantly decrease the incidence of intracranial artery stenosis exacerbation (MRA: combined OR 0.22, 95% CI (0.07, 0.68); TCD: combined OR 0.17, 95% CI (0.05, 0.51)). In terms of adverse reactions, there were slightly fewer incidences of major bleeding with cilostazol than with aspirin (combined OR 0.38, 95% CI (0.24, 0.60)), and there was no difference in the number of heart palpitations between cilostazol and aspirin. However, the incidence of gastrointestinal disorders, dizziness, and headaches caused by cilostazol was greater.
Cilostazol might be a more effective and safer alternative to aspirin for patients with ischemic stroke. Further studies are required to confirm whether cilostazol is a suitable therapeutic option for secondary stroke prevention in larger cohorts of patients with ischemic stroke.
为了研究西洛他唑在缺血性脑卒中预防和治疗中的疗效和安全性，我们对相关临床随机对照试验进行了系统评价。
我们检索了主要数据库中符合条件的试验，包括从 1966 年 1 月到 2012 年 11 月的 MEDLINE 文献、1980 年到 2012 年 11 月的 EMBASE 报告，以及 EBSCO、Springer、Ovid 和 Cochrane 图书馆引文库中的所有研究。我们还检索了西洛他唑和阿司匹林等关键词。使用 RevMan 5.0 软件进行荟萃分析。
我们的检索结果共纳入 5 项试验。西洛他唑和阿司匹林在预防和治疗缺血性脑卒中方面的效果几乎相当（联合优势比（OR）0.78，95%置信区间（CI）（0.59，1.04））。此外，磁共振血管造影（MRA）和经颅多普勒（TCD）检查均显示，西洛他唑可显著降低颅内动脉狭窄加重的发生率（MRA：联合 OR 0.22，95%CI（0.07，0.68）；TCD：联合 OR 0.17，95%CI（0.05，0.51））。在不良反应方面，西洛他唑发生大出血的发生率略低于阿司匹林（联合 OR 0.38，95%CI（0.24，0.60）），且心悸的发生率与阿司匹林无差异。然而，西洛他唑引起胃肠道紊乱、头晕和头痛的发生率更高。
西洛他唑可能是缺血性脑卒中患者比阿司匹林更有效和更安全的选择。需要进一步的研究来证实西洛他唑是否是更大的缺血性脑卒中患者亚组二级预防的合适治疗选择。
