Wang Wen, Zhang Lu, Liu Weiming, Zhu Qin, Lan Qing, Zhao Jizong
Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Ophthalmology, School of Medicine, Shandong University, Jinan, China.
J Stroke Cerebrovasc Dis. 2016 May;25(5):1081-1089. doi: 10.1016/j.jstrokecerebrovasdis.2016.01.026. Epub 2016 Feb 5.
Stroke can cause high morbidity and mortality, and ischemic stroke (IS) and transient ischemic attack (TIA) patients have a high stroke recurrence rate. Antiplatelet agents are the standard therapy for these patients, but it is often difficult for clinicians to select the best therapy from among the multiple treatment options. We therefore performed a network meta-analysis to estimate the efficacy of antiplatelet agents for secondary prevention of recurrent stroke. We systematically searched 3 databases (PubMed, Embase, and Cochrane) for relevant studies published through August 2015. The primary end points of this meta-analysis were overall stroke, hemorrhagic stroke, and fatal stroke. A total of 30 trials were included in our network meta-analysis and abstracted data. Among the therapies evaluated in the included trials, the estimates for overall stroke and hemorrhagic stroke for cilostazol (Cilo) were significantly better than those for aspirin (odds ratio [OR] = .64, 95% credibility interval [CrI], .45-.91; OR = .23, 95% CrI, .08-.58). The estimate for fatal stroke was highest for Cilo plus aspirin combination therapy, followed by Cilo therapy. The results of our meta-analysis indicate that Cilo significantly improves overall stroke and hemorrhagic stroke in IS or TIA patients and reduces fatal stroke, but with low statistical significance. Our results also show that Cilo was significantly more efficient than other therapies in Asian patients; therefore, future trials should focus on Cilo treatment for secondary prevention of recurrent stroke in non-Asian patients.
中风可导致高发病率和死亡率，缺血性中风（IS）和短暂性脑缺血发作（TIA）患者的中风复发率很高。抗血小板药物是这些患者的标准治疗方法，但临床医生往往难以从多种治疗方案中选择最佳治疗方法。因此，我们进行了一项网状荟萃分析，以评估抗血小板药物对复发性中风二级预防的疗效。我们系统检索了3个数据库（PubMed、Embase和Cochrane），以获取截至2015年8月发表的相关研究。这项荟萃分析的主要终点是总体中风、出血性中风和致命性中风。我们的网状荟萃分析共纳入30项试验并提取了数据。在所纳入试验评估的治疗方法中，西洛他唑（Cilo）对总体中风和出血性中风的估计显著优于阿司匹林（优势比[OR]=0.64，95%可信度区间[CrI]，0.45 - 0.91；OR = 0.23，95% CrI，0.08 - 0.58）。西洛他唑加阿司匹林联合治疗的致命性中风估计最高，其次是西洛他唑治疗。我们的荟萃分析结果表明，西洛他唑显著改善IS或TIA患者的总体中风和出血性中风，并降低致命性中风，但统计学意义较低。我们的结果还表明，西洛他唑在亚洲患者中比其他治疗方法显著更有效；因此，未来的试验应关注西洛他唑对非亚洲患者复发性中风二级预防的治疗。
