New options for cilostazol-based dual antiplatelet therapy for ischaemic stroke prevention in East Asian populations: a systematic review and meta-analysis
Background and purposeThe objective of this study is to systematically review the efficacy and safety of cilostazol-based dual antiplatelet therapy (DAPT) in patients with stroke.MethodsTwo reviewers conducted a comprehensive search of eligible studies published in PubMed, Medline, the Cochrane Libr...
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Frontiers Media S.A.
2025-02-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2025.1533674/full |
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| author | Xiaorui Wang Yixin Wang Qiang Zheng Pengwei Li Jingli Yin Miaomiao Wang Liangyu Zou Jie Wang Jialin Pan Lei Qin Song Luo Lijuan Yang |
| author_facet | Xiaorui Wang Yixin Wang Qiang Zheng Pengwei Li Jingli Yin Miaomiao Wang Liangyu Zou Jie Wang Jialin Pan Lei Qin Song Luo Lijuan Yang |
| author_sort | Xiaorui Wang |
| collection | DOAJ |
| description | Background and purposeThe objective of this study is to systematically review the efficacy and safety of cilostazol-based dual antiplatelet therapy (DAPT) in patients with stroke.MethodsTwo reviewers conducted a comprehensive search of eligible studies published in PubMed, Medline, the Cochrane Library, Embase, and four Chinese databases from their establishment to 31 July 2024. The review was registered (CRD42024559047).ResultsThis study included a total of 4,473 subjects from 11 studies. The results indicated that, when compared to aspirin/clopidogrel single antiplatelet therapy (SAPT), cilostazol-based DAPT was associated with lower ischemic stroke (RR = 0.54, 95% CI 0.38–0.75, P = 0.0003) and any stroke recurrence (RR = 0.52, 95% CI 0.31–0.86, P = 0.01). Furthermore, the incidence of general adverse events was higher in the cilostazol-based DAPT (RR = 1.93, 95% CI 1.16–3.21, P = 0.01), while no statistically significant difference was observed between the two groups with regard to serious adverse events. The subgroup analysis of follow-up time revealed that the cilostazol-based DAPT regimen demonstrated superior efficacy in reducing the incidence of ischemic stroke recurrence (RR = 0.51; 95% CI 0.36–0.73; P = 0.0002) and any stroke recurrence (RR = 0.49; 95% CI 0.35–0.67; P < 0.0001) in the long-term (>3 months) versus the short-term (≤3 months) group. Furthermore, the cilostazol-based DAPT regimen did not increase the risk of serious adverse events.ConclusionDAPT combined with cilostazol and aspirin or clopidogrel was superior to aspirin or clopidogrel alone, did not increase serious adverse events, and was more effective for long-term (>3 months) prophylaxis.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024559047 |
| format | Article |
| id | doaj-art-14bf1f3ed5c7438fa4895dc45414db5f |
| institution | DOAJ |
| issn | 1663-9812 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pharmacology |
| spelling | doaj-art-14bf1f3ed5c7438fa4895dc45414db5f2025-08-20T03:11:47ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122025-02-011610.3389/fphar.2025.15336741533674New options for cilostazol-based dual antiplatelet therapy for ischaemic stroke prevention in East Asian populations: a systematic review and meta-analysisXiaorui Wang0Yixin Wang1Qiang Zheng2Pengwei Li3Jingli Yin4Miaomiao Wang5Liangyu Zou6Jie Wang7Jialin Pan8Lei Qin9Song Luo10Lijuan Yang11Department of Neurology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, ChinaDepartment of Pediatrics, The First Affiliated Hospital of Bengbu Medical University, Bengbu, ChinaDepartment of Neurology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, ChinaDepartment of Neurology, Yichuan People’s Hospital, Luoyang, ChinaDepartment of Emergency, Yichuan People’s Hospital, Luoyang, ChinaDepartment of Neurology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, ChinaDepartment of Neurology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, Shenzhen, ChinaInternational Medical Center (Department of Geriatric Medicine), Shenzhen University General Hospital, Shenzhen, ChinaDepartment of Internal Medicine, Second People’s Hospital, Longgang, Shenzhen, ChinaDepartment of Radiology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, ChinaDepartment of Neurology, The First Affiliated Hospital of Bengbu Medical University, Bengbu, ChinaDepartment of Pediatrics, The First Affiliated Hospital of Bengbu Medical University, Bengbu, ChinaBackground and purposeThe objective of this study is to systematically review the efficacy and safety of cilostazol-based dual antiplatelet therapy (DAPT) in patients with stroke.MethodsTwo reviewers conducted a comprehensive search of eligible studies published in PubMed, Medline, the Cochrane Library, Embase, and four Chinese databases from their establishment to 31 July 2024. The review was registered (CRD42024559047).ResultsThis study included a total of 4,473 subjects from 11 studies. The results indicated that, when compared to aspirin/clopidogrel single antiplatelet therapy (SAPT), cilostazol-based DAPT was associated with lower ischemic stroke (RR = 0.54, 95% CI 0.38–0.75, P = 0.0003) and any stroke recurrence (RR = 0.52, 95% CI 0.31–0.86, P = 0.01). Furthermore, the incidence of general adverse events was higher in the cilostazol-based DAPT (RR = 1.93, 95% CI 1.16–3.21, P = 0.01), while no statistically significant difference was observed between the two groups with regard to serious adverse events. The subgroup analysis of follow-up time revealed that the cilostazol-based DAPT regimen demonstrated superior efficacy in reducing the incidence of ischemic stroke recurrence (RR = 0.51; 95% CI 0.36–0.73; P = 0.0002) and any stroke recurrence (RR = 0.49; 95% CI 0.35–0.67; P < 0.0001) in the long-term (>3 months) versus the short-term (≤3 months) group. Furthermore, the cilostazol-based DAPT regimen did not increase the risk of serious adverse events.ConclusionDAPT combined with cilostazol and aspirin or clopidogrel was superior to aspirin or clopidogrel alone, did not increase serious adverse events, and was more effective for long-term (>3 months) prophylaxis.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024559047https://www.frontiersin.org/articles/10.3389/fphar.2025.1533674/fullischaemic strokecilostazoldual antiplatelet therapymeta-analysissystematic review |
| spellingShingle | Xiaorui Wang Yixin Wang Qiang Zheng Pengwei Li Jingli Yin Miaomiao Wang Liangyu Zou Jie Wang Jialin Pan Lei Qin Song Luo Lijuan Yang New options for cilostazol-based dual antiplatelet therapy for ischaemic stroke prevention in East Asian populations: a systematic review and meta-analysis Frontiers in Pharmacology ischaemic stroke cilostazol dual antiplatelet therapy meta-analysis systematic review |
| title | New options for cilostazol-based dual antiplatelet therapy for ischaemic stroke prevention in East Asian populations: a systematic review and meta-analysis |
| title_full | New options for cilostazol-based dual antiplatelet therapy for ischaemic stroke prevention in East Asian populations: a systematic review and meta-analysis |
| title_fullStr | New options for cilostazol-based dual antiplatelet therapy for ischaemic stroke prevention in East Asian populations: a systematic review and meta-analysis |
| title_full_unstemmed | New options for cilostazol-based dual antiplatelet therapy for ischaemic stroke prevention in East Asian populations: a systematic review and meta-analysis |
| title_short | New options for cilostazol-based dual antiplatelet therapy for ischaemic stroke prevention in East Asian populations: a systematic review and meta-analysis |
| title_sort | new options for cilostazol based dual antiplatelet therapy for ischaemic stroke prevention in east asian populations a systematic review and meta analysis |
| topic | ischaemic stroke cilostazol dual antiplatelet therapy meta-analysis systematic review |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2025.1533674/full |
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