Department of Neurosurgery, West China Hospital, Sichuan University and West China Brain Research Centre, No. 37 Guo Xue Xiang, Chengdu, Sichuan, China.
Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
J Neurol. 2020 Jun;267(6):1577-1584. doi: 10.1007/s00415-019-09198-z. Epub 2019 Feb 9.
Delayed cerebral ischemia seriously affects the prognosis of patients surviving the initial aneurysmal subarachnoid hemorrhage. Application of cilostazol was reported to ameliorate vasospasm and improve outcomes in series and clinical trials. But the effectiveness and feasibility of cilostazol on aneurysmal subarachnoid hemorrhage remained controversial. We performed a systematic review to clarify this issue.
PubMed, Ovid and Cochrane library database were systematically searched up to May 2018 for eligible publications in English. Quality assessment was conducted for included studies. Meta-analysis was conducted to evaluate the overall effect on events of interest. Subgroup analyses and sensitivity analyses were used to check whether the results were robust. Publication bias was evaluated with the funnel plot.
Pooled analyses found cilostazol significantly reduced incidences of severe angiographic vasospasm (p = 0.0001), symptomatic vasospasm (p < 0.00001), new cerebral infarction (p < 0.00001) and the poor outcome (p < 0.0001). Subgroup and sensitivity analyses achieved consistent results. There was no statistical difference between cilostazol and the control group in reducing mortality (p = 0.07). But sensitivity analysis changed the result after excluding one study. Under the prescribed dosage, complication was few and non-lethal.
Cilostazol was effective and safe to reduce incidences of severe angiographic vasospasm, symptomatic vasospasm, new cerebral infarction and poor outcome in patients after aneurysmal subarachnoid hemorrhage. However, its effect on mortality and the interactive effect with nimodipine warranted further research.
迟发性脑缺血严重影响颅内动脉瘤性蛛网膜下腔出血患者的预后。西洛他唑在系列和临床试验中被报道可改善血管痉挛并改善结果。但是西洛他唑对颅内动脉瘤性蛛网膜下腔出血的有效性和可行性仍存在争议。我们进行了系统评价以澄清这个问题。
系统地检索了截至 2018 年 5 月的英文文献，包括 PubMed、Ovid 和 Cochrane 图书馆数据库，以查找合格的出版物。对纳入的研究进行了质量评估。进行了荟萃分析以评估对感兴趣事件的总体影响。进行了亚组分析和敏感性分析，以检查结果是否稳健。使用漏斗图评估发表偏倚。
汇总分析发现西洛他唑可显著降低严重血管造影性血管痉挛（p=0.0001）、症状性血管痉挛（p<0.00001）、新脑梗死（p<0.00001）和不良结局（p<0.0001）的发生率。亚组和敏感性分析得出了一致的结果。在降低死亡率方面，西洛他唑与对照组之间无统计学差异（p=0.07）。但是，在排除一项研究后，敏感性分析改变了结果。在规定剂量下，并发症很少且无致命性。
西洛他唑可有效且安全地降低颅内动脉瘤性蛛网膜下腔出血患者严重血管造影性血管痉挛、症状性血管痉挛、新脑梗死和不良结局的发生率。然而，其对死亡率的影响和与尼莫地平的相互作用需要进一步研究。
