Cilostazole ( Antipalteletes) in stroke prevention: A meta analysis of clinical trails

Cilostazol is an antiplatelet agent that inhibits phosphodiesterase III in platelets and vascular endothelium. Many RCTs have demonstrated the efficacy and safety of cilostazol, but the data were limited. A research team from Tokyo Women’s Medical University in Japan conducted a meta-analysis of these RCTs to verify the effects of cilostazol on ischaemic and haemorrhagic events.

Data from 13 randomized placebo-controlled trials involving 6165 patients were analysed. Endpoints examined for safety and efficacy were cerebrovascular events, cardiovascular events and bleeding complications. Relative risk and 95% confidence interval were estimated using the Mantel-Haeszel model.

The results showed that the 13 trials included 10 trials in patients with peripheral artery disease, 2 in those with cerebrovascular disease and 1 in those with coronary stenting. Of 6165 patients, 4383 (71%) patients were males, and mean age was 64.9 years. There was no difference in patient backgrounds between the groups. Incidence of total vascular events was significantly lower in the cilostazol group.

A significantly lower incidence of cerebrovascular events was seen in the cilostazol group compared to the placebo group but there was no significant difference in the incidence of cardiovascular events between the groups. There was no difference in the incidence of serious bleeding complications between the cilostazol (1.4%) and placebo (1.5%) groups.

This first meta-analysis of Cilostazol conducted on over 6000 patients with a history of vascular events demonstrated a great preventive effect of cilostazol on cerebrovascular events with no associated increase in cardiovascular or bleeding risks.