Meta-Analysis of Cilostazol Versus Aspirin for the Secondary Prevention of Stroke Article

Full Text via DOI: 10.1016/j.amjcard.2013.05.067 PMID: 23827403 Web of Science: 000325833700028

Cited authors

  • DiNicolantonio, James J.; Lavie, Carl J.; Fares, Hassan; Menezes, Arthur R.; O'Keefe, James H.; Bangalore, Sripal; Messerli, Franz H.


  • Aspirin is the most widely prescribed antiplatelet agent for the secondary prevention of stroke. Cilostazol, an antiplatelet and vasodilating agent, has shown promise for the secondary prevention of stroke. A systematic review and meta-analysis of randomized controlled trials using Ovid MEDLINE, PubMed, and Excerpta Medica (EMBASE) was searched up to October 2012. Four trials, in 3,917 patients, comparing cilostazol with aspirin were identified. Compared with aspirin, cilostazol was associated with a 73% reduction in hemorrhagic stroke (relative risk [RR] 0.27, 95% confidence interval [CI] 0.13 to 0.54, p = 0.0002), 28% reduction in the composite end point of stroke, myocardial infarction, or vascular death (RR 0.72, 95% CI 0.57 to 0.89, p = 0.003), and 48% reduction in total hemorrhagic events (RR 0.52, 95% CI 0.34 to 0.79, p = 0.002), with trend for lesser gastrointestinal bleeds (RR 0.60, 95% CI 0.34 to 1.06, p = 0.08). In conclusion, compared with aspirin, cilostazol is associated with significantly less hemorrhagic stroke, the combined end point of stroke, myocardial infarction, and vascular death, and total hemorrhagic events, with numerically fewer gastrointestinal bleeds when used for the secondary prevention of stroke. (C) 2013 Elsevier Inc. All rights reserved.

Publication date

  • 2013

Published in

International Standard Serial Number (ISSN)

  • 0002-9149

Start page

  • 1230

End page

  • 1234


  • 112


  • 8