Tan Liang, Margaret Barnhart, Zhang John H, Hu Rong, Yin Yi, Cao Liu, Feng Hua, Zhang Yanqi
Department of Neurosurgery and Key Laboratory of Neurotrauma, Southwest Hospital, Third Military Medical University, Chongqing, China.
Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, California.
J Stroke Cerebrovasc Dis. 2015 May;24(5):930-8. doi: 10.1016/j.jstrokecerebrovasdis.2014.12.002. Epub 2015 Mar 21.
Antiplatelet therapy is recommended for patients who have experienced ischemic stroke. We performed a meta-analysis to compare the efficacy and safety of cilostazol with other antiplatelet therapies in patients with ischemic stroke.
PubMed, EMBASE, MEDLINE, and the Cochrane Library were searched for randomized controlled trials published in English from May 1999 to May 2013. Clinical outcomes were compared by pooled and meta-regression analyses.
Nine studies involving 6328 patients satisfied our inclusion criteria. Stroke recurrence (including hemorrhagic and ischemic) with cilostazol use was 5.3% (157) versus 8.3% (248) in control group (risk ratio .63 [.52-.76], 95% confidence interval [CI]). Poststroke intracranial hemorrhage was .5% (16) with cilostazol versus 1.6% (46) in control group (risk ratio .36 [.21-.63], 95% CI). Poststroke extracranial bleeding complications occurred in 2.4% (66) of the patients taking cilostazol versus 3.9% (108) in control group (risk ratio .62 [.46-.83], 95% CI). No significant difference in cerebrovascular events (nonfatal stroke, intracranial hemorrhage, and transient ischemic attack) was found between the cilostazol group (8.2%, 246) versus control group (12.0%, 360; risk ratio .71 [.50-1.01], 95% CI). In addition, the cilostazol therapy brought about a nonsignificant reduction of cardiac adverse events (heart failure, myocardial infarction, and angina pectoris) comparing with control groups, with 3.8% (99) of the cilostazol group versus 4.7% (123) of control group (risk ratio, .81 [.62-1.04], 95% CI).
Cilostazol, alone or in combination with aspirin, significantly reduces stroke recurrence, poststroke intracranial hemorrhage, and extracranial bleeding in patients with a prior ischemic stroke as compared with other antiplatelet therapies.
对于经历过缺血性卒中的患者，推荐使用抗血小板治疗。我们进行了一项荟萃分析，以比较西洛他唑与其他抗血小板治疗方法在缺血性卒中患者中的疗效和安全性。
检索PubMed、EMBASE、MEDLINE和Cochrane图书馆，查找1999年5月至2013年5月以英文发表的随机对照试验。通过汇总分析和Meta回归分析比较临床结局。
9项涉及6328例患者的研究符合我们的纳入标准。使用西洛他唑的卒中复发（包括出血性和缺血性）率为5.3%（157例），而对照组为8.3%（248例）（风险比0.63[0.52 - 0.76]，95%置信区间[CI]）。西洛他唑治疗后颅内出血率为0.5%（16例），对照组为1.6%（46例）（风险比0.36[0.21 - 0.63]，95%CI）。服用西洛他唑的患者发生颅外出血并发症的比例为2.4%（66例），对照组为3.9%（108例）（风险比0.62[0.46 - 0.83]，95%CI）。西洛他唑组（8.2%，246例）与对照组（12.0%，360例；风险比0.71[0.50 - 1.01]，95%CI）之间在脑血管事件（非致命性卒中、颅内出血和短暂性脑缺血发作）方面未发现显著差异。此外，与对照组相比，西洛他唑治疗使心脏不良事件（心力衰竭、心肌梗死和心绞痛）有非显著降低，西洛他唑组为3.8%（99例），对照组为4.7%（123例）（风险比0.81[0.62 - 1.04]，95%CI）。
与其他抗血小板治疗方法相比，西洛他唑单独或与阿司匹林联合使用，可显著降低既往有缺血性卒中患者的卒中复发、卒中后颅内出血和颅外出血。
