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SYSTEMATIC REVIEW article

Front. Pharmacol.
Sec. Neuropharmacology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1533674
This article is part of the Research Topic Advancements in Translational Stroke Research: Spotlight on the Blood-Brain Barrier View all articles

New options for cilostazol-based dual antiplatelet therapy for ischaemic stroke prevention in East Asian populations: a systematic review and meta-analysis

Provisionally accepted
Xiaorui Wang Xiaorui Wang 1Yixin Wang Yixin Wang 1Qiang Zheng Qiang Zheng 1Pengwei Li Pengwei Li 2Jingli Yin Jingli Yin 2Miaomiao Wang Miaomiao Wang 1Zou Liangyu Zou Liangyu 3Jie Wang Jie Wang 4Jialin Pan Jialin Pan 5Lei Qin Lei Qin 1Song Luo Song Luo 1*Li-juan Yang Li-juan Yang 1*
  • 1 The first affiliated hospital of Bengbu medical university, Bengbu, China
  • 2 Yichuan People's Hospital, Luoyang, China
  • 3 Shenzhen People's Hospital, Jinan University, Shenzhen, Guangdong Province, China
  • 4 Shenzhen University General Hospital, Shenzhen, China
  • 5 The Second People's Hospital of Longgang District, Shenzhen, China

The final, formatted version of the article will be published soon.

    The objective of this study is to systematically review the efficacy and safety of cilostazol-based dual antiplatelet therapy (DAPT) in patients with stroke.Two reviewers conducted a comprehensive search of eligible studies published in PubMed, Medline, the Cochrane Library, Embase, and four Chinese databases from their establishment to July 31, 2024. The review was registered (CRD42024559047).This study included a total of 4473 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. CONCLUSIONS: DAPT 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.

    Keywords: ischaemic stroke, cilostazol, Dual antiplatelet therapy, Meta-analysis, Systematic review

    Received: 24 Nov 2024; Accepted: 29 Jan 2025.

    Copyright: © 2025 Wang, Wang, Zheng, Li, Yin, Wang, Liangyu, Wang, Pan, Qin, Luo and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Song Luo, The first affiliated hospital of Bengbu medical university, Bengbu, China
    Li-juan Yang, The first affiliated hospital of Bengbu medical university, Bengbu, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.