Abstract
Background: Cilostazol is an antiplatelet agent that inhibits phosphodiesterase III in platelets and vascular endothelium. Previous randomized controlled trials of cilostazol for prevention of cerebrovascular events have garnered mixed results. We performed a systematic review and meta-analysis of the randomized clinical trials in patients with atherothrombotic diseases to determine the effects of cilostazol on cerebrovascular, cardiac, and all vascular events, and on all major hemorrhagic events. Methods: Relevant trials were identified by searching MEDLINE, EMBASE, and the Cochrane Controlled Trial Registry for titles and abstracts. Data from 12 randomized controlled trials, involving 5674 patients, were analyzed for end points of cerebrovascular, cardiac, and major bleeding events. Searching, determination of eligibility, data extraction, and meta-analyses were conducted by multiple independent investigators. Results: Data were available in 3782, 1187, and 705 patients with peripheral arterial disease, cerebrovascular disease, and coronary stenting, respectively. Incidence of total vascular events was significantly lower in the cilostazol group compared with the placebo group (relative risk [RR], 0.86; 95% confidence interval [CI], 0.74-0.99; P=.038). This was particularly influenced by a significant decrease of incidence of cerebrovascular events in the cilostazol group (RR, 0.58; 95% CI, 0.43-0.78; P < .001). There was no significant intergroup difference in incidence of cardiac events (RR, 0.99; 95% CI, 0.83-1.17; P=.908) and serious bleeding complications (RR, 1.00; 95% CI, 0.66-1.51; P=.996). Conclusions: This first meta-analysis of cilostazol in patients with atherothrombosis demonstrated a significant risk reduction for cerebrovascular events, with no associated increase of bleeding risk.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 482-490 |
| Number of pages | 9 |
| Journal | Journal of Stroke and Cerebrovascular Diseases |
| Volume | 18 |
| Issue number | 6 |
| DOIs | |
| State | Published - Nov 2009 |
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Keywords
- atherothrombosis
- cerebrovascular disorders
- cilostazol
- Meta-analysis
- phosphodiesterase inhibitor
- platelet aggregation inhibitor
- prevention
- stroke
- vascular endothelium
ASJC Scopus subject areas
- Clinical Neurology
- Surgery
- Rehabilitation
- Cardiology and Cardiovascular Medicine
Cite this
Stroke Prevention by Cilostazol in Patients with Atherothrombosis : Meta-analysis of Placebo-controlled Randomized Trials. / Uchiyama, Shinichiro; Demaerschalk, Bart M; Goto, Shinya; Shinohara, Yukito; Gotoh, Fumio; Stone, William M.; Money, Samuel R.; Kwon, Sun Uck.
In: Journal of Stroke and Cerebrovascular Diseases, Vol. 18, No. 6, 11.2009, p. 482-490.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Stroke Prevention by Cilostazol in Patients with Atherothrombosis
T2 - Meta-analysis of Placebo-controlled Randomized Trials
AU - Uchiyama, Shinichiro
AU - Demaerschalk, Bart M
AU - Goto, Shinya
AU - Shinohara, Yukito
AU - Gotoh, Fumio
AU - Stone, William M.
AU - Money, Samuel R.
AU - Kwon, Sun Uck
PY - 2009/11
Y1 - 2009/11
N2 - Background: Cilostazol is an antiplatelet agent that inhibits phosphodiesterase III in platelets and vascular endothelium. Previous randomized controlled trials of cilostazol for prevention of cerebrovascular events have garnered mixed results. We performed a systematic review and meta-analysis of the randomized clinical trials in patients with atherothrombotic diseases to determine the effects of cilostazol on cerebrovascular, cardiac, and all vascular events, and on all major hemorrhagic events. Methods: Relevant trials were identified by searching MEDLINE, EMBASE, and the Cochrane Controlled Trial Registry for titles and abstracts. Data from 12 randomized controlled trials, involving 5674 patients, were analyzed for end points of cerebrovascular, cardiac, and major bleeding events. Searching, determination of eligibility, data extraction, and meta-analyses were conducted by multiple independent investigators. Results: Data were available in 3782, 1187, and 705 patients with peripheral arterial disease, cerebrovascular disease, and coronary stenting, respectively. Incidence of total vascular events was significantly lower in the cilostazol group compared with the placebo group (relative risk [RR], 0.86; 95% confidence interval [CI], 0.74-0.99; P=.038). This was particularly influenced by a significant decrease of incidence of cerebrovascular events in the cilostazol group (RR, 0.58; 95% CI, 0.43-0.78; P < .001). There was no significant intergroup difference in incidence of cardiac events (RR, 0.99; 95% CI, 0.83-1.17; P=.908) and serious bleeding complications (RR, 1.00; 95% CI, 0.66-1.51; P=.996). Conclusions: This first meta-analysis of cilostazol in patients with atherothrombosis demonstrated a significant risk reduction for cerebrovascular events, with no associated increase of bleeding risk.
AB - Background: Cilostazol is an antiplatelet agent that inhibits phosphodiesterase III in platelets and vascular endothelium. Previous randomized controlled trials of cilostazol for prevention of cerebrovascular events have garnered mixed results. We performed a systematic review and meta-analysis of the randomized clinical trials in patients with atherothrombotic diseases to determine the effects of cilostazol on cerebrovascular, cardiac, and all vascular events, and on all major hemorrhagic events. Methods: Relevant trials were identified by searching MEDLINE, EMBASE, and the Cochrane Controlled Trial Registry for titles and abstracts. Data from 12 randomized controlled trials, involving 5674 patients, were analyzed for end points of cerebrovascular, cardiac, and major bleeding events. Searching, determination of eligibility, data extraction, and meta-analyses were conducted by multiple independent investigators. Results: Data were available in 3782, 1187, and 705 patients with peripheral arterial disease, cerebrovascular disease, and coronary stenting, respectively. Incidence of total vascular events was significantly lower in the cilostazol group compared with the placebo group (relative risk [RR], 0.86; 95% confidence interval [CI], 0.74-0.99; P=.038). This was particularly influenced by a significant decrease of incidence of cerebrovascular events in the cilostazol group (RR, 0.58; 95% CI, 0.43-0.78; P < .001). There was no significant intergroup difference in incidence of cardiac events (RR, 0.99; 95% CI, 0.83-1.17; P=.908) and serious bleeding complications (RR, 1.00; 95% CI, 0.66-1.51; P=.996). Conclusions: This first meta-analysis of cilostazol in patients with atherothrombosis demonstrated a significant risk reduction for cerebrovascular events, with no associated increase of bleeding risk.
KW - atherothrombosis
KW - cerebrovascular disorders
KW - cilostazol
KW - Meta-analysis
KW - phosphodiesterase inhibitor
KW - platelet aggregation inhibitor
KW - prevention
KW - stroke
KW - vascular endothelium
UR - http://www.scopus.com/inward/record.url?scp=70350717086&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=70350717086&partnerID=8YFLogxK
U2 - 10.1016/j.jstrokecerebrovasdis.2009.07.010
DO - 10.1016/j.jstrokecerebrovasdis.2009.07.010
M3 - Article
VL - 18
SP - 482
EP - 490
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
SN - 1052-3057
IS - 6
ER -