Use of Cilostazol for Secondary Stroke Prevention: An Old Dog with New Tricks?
Abstract
Abstract
Objective:
To evaluate the safety and efficacy of cilostazol for secondary prevention of non-cardioembolic ischemic stroke.
Data Sources:
PubMed and MEDLINE searches were performed (January 1970-September 2011) using the key words cilostazol, antiplatelet, aspirin, acetylsalicylic acid, secondary stroke prevention, ischemic stroke, intracerebral hemorrhage, intracranial, cerebrovascular accident, and transient ischemic attack. Additionally, reference citations from publications identified were reviewed.
Study Selection and Data Extraction:
Articles published in English and relevant primary literature evaluating the efficacy and safety of cilostazol in the secondary prevention of atherosclerotic ischemic stroke were included.
Data Synthesis:
Antiplatelet therapy plays a vital role in the multifaceted approach to secondary stroke prevention. Current American Heart Association/American Stroke Association clinical guidelines for secondary stroke prevention support the use of aspirin, Clopidogrel, and combination aspirin/extended-release dipyridamole. The antiplatelet, antithrombotic, and vasoditatory effects of cilostazol make it a potential alternative agent for atherosclerotic stroke prevention. Recent literature has demonstrated superior efficacy of cilostazol 100 mg twice daily for secondary stroke prevention compared to placebo and aspirin. Three clinical trials were reviewed (1 placebo-controlled, 2 aspirin-controlled), all of which were conducted in Japan or China. Cilostazol reduced the primary outcome of recurrence of stroke, with significantly fewer major bleeding events when compared to aspirin.
Conclusions:
Available literature suggests that cilostazol may be safer and more effective than aspirin in the secondary prevention of stroke in Asian patients. Further large-scale studies in more heterogeneous study populations are warranted to determine whether cilostazol is a viable therapeutic option for patients with a history of non-cardioembolic ischemic stroke.
Resumen
Objettvo:
Evaluar la eficacia y seguridad de cilostazol en prevención secundaria de un accidente cerebrovascular o una apoplejía isquémica no cardioembólica.
Fuentes De Datos:
Se realizó un búsqueda en los sistemas de datós PubMed y MEDLINE (enero 1970 hasta septiembre 2011) utilizando los siguientes términos: cilostazol, antiplaquetario, aspirina, acido acetilsalicílico, prevención secundaria de apoplejía, apoplejía isquémica, hemorragia intracerebral, intracranial, accidente cerebrovascular y ataque isquémico temporero. También se revisaron las referencias de las publicacions identificadas.
Selección De Estodios Y Extracción De Datos:
Se incluyeron para estudio los artículos de literatura primaria relevantes, publicados en el idioma inglés, que evaluaban la eficacia y seguridad de cilostazol en la prevención secundaria de apoplejía isquémica aterosclerótica.
Síntesis De Datos:
La terapia antiplaquetaria tiene una función vital en los acercamientos multifacéficos para la prevención secundaria de una apoplejía. Las guías actuates de la Asociación Americana del Corazón y la Asociación Americana de Apoplejía (Stroke) para prevención secundaria de accidentes cerebrovasculares apoyan el uso de aspirina, clopidrogel y la combinación aspirina/dipiridamole de liberación extendida. Los efectos antiplaquetarios, antitrombóticos y vasodilatadores que tiene cilostazol lo hacen un agente alterno potential para la prevención de apoplejía aterosclerótica. La literatura retiente ha demostrado una eficacia superior de cilostazol 100 mg 2 veces al día para prevención secundaria de apoplejía al compararlo con placebo y aspirina. Se revisaron 3 estudios clínicos, 1 control placebo y 2 con control de aspirina. Cilostazol redujo la ocurrencia de apoplejía significativamente con menos eventes de sangrado mayor, cuando se comparó con aspirina.
Conclusiones:
La literatura disponible sugiere que cilostazol puede ser mas seguro y efectivo que aspirina en la prevención secundaria de apoplejía en personas de Asia. Se necesitan estudios más grandes con poblaciones heterogéneos para determinar si cilostazol es una opción terapéutica viable en patientes con historial de apoplejía isquémica no-cardioembólica.
Résumé
Objectif:
Evaluer l'innocuité et l'efficacité du cilostazol pour la prévention secondaire des AVC ischémiques.
Sources De Données:
Une recherche dans PubMed et MEDLINE a été réalisée (janvier 1970-septembre 2011) en utilisant les mots-clés cilostazol, antiplatelet, aspirin, acetylsalicylic acid, secondary stroke prevention, ischemic stroke, intracerebral hemorrhage, intracranial, cerebrovascular accident et transient ischemic attack. De plus, les références des publications identifiées ont été examinées.
Sélection Des études Et Extraction Des Données:
Les articles publiés en langue anglaise évaluant l'efficacité et l'innocuité du cilostazol dans la prévention secondaire des AVC ischémiques secondaires à de l'athérosclérose ont été inclus dans cette revue.
Synthese Des Données:
Le traitement antiplaquettaire joue un rôle essentiel dans la prévention secondaire de l'AVC. Les lignes directrices de l'American Heart Association/American Stroke Association pour la prévention secondaire de l'AVC recommande l'utilisation de l'aspirine, du clopidogrel et de la combinaison aspirine/dipyridamole à libération prolongée. Les effets anti-plaquettaire, anti-thrombotique et vasodilatateur observés avec le cilostazol en font un agent potentiel pour la prévention de l'AVC secondaire à l'athérosclérose. La littérature récente a démontré une efficacité supérieure du cilostazol 100 mg deux fois par jour pour la prévention secondaire de l'AVC, comparativement au placebo et à l'aspirine. Trois essais cliniques ont été examinés (1 contrôlé par placebo, 2 contrôlés par l'aspirine). Le cilostazol a été associé à une réduction d'un second épisode d'AVC avec moins d'événements hémorragiques majeurs par rapport à l'aspirine.
Conclusions:
La littérature disponible suggère que le cilostazol pourrait ětre plus sûre et plus efficace que l'aspirine dans la prévention secondaire des accidents vasculaires cérébraux chez les patients asiatiques. D'autres études à grande échelle dans des populations plus hétérogènes sont nécessaires afin de déterminer si le cilostazol pourrait ětre une option thérapeutique viable pour les patients ayant des antécédents d'AVC non-cardioembolique.
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Article first published online: February 21, 2012
Issue published: March 2012
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PubMed: 22353234
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