Effect of cilostazol in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis
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Published on: June 18, 2021
Peng-Peng Niu1, Ge Yang2, Ying-Qi Xing1
1Department of Neurology, The First Hospital of Jilin University, Xinmin Street 71#, Changchun 130021, China.
Insights
Cilostazol significantly reduces the risk of symptomatic vasospasm, cerebral infarctions, and poor outcomes in patients following aneurysmal subarachnoid hemorrhage (SAH). This finding supports its use in managing SAH complications.
Area of Science:
- Neurology
- Pharmacology
- Clinical Medicine
Background:
- Aneurysmal subarachnoid hemorrhage (SAH) is a critical condition often leading to cerebral vasospasm.
- Previous small studies suggested cilostazol may mitigate vasospasm risk.
- Effective treatments for preventing SAH complications are crucial.
Purpose of the Study:
- To evaluate the efficacy of cilostazol in preventing cerebral vasospasm and related complications in patients with aneurysmal SAH.
- To synthesize evidence from available clinical trials on cilostazol's impact on SAH outcomes.
Main Methods:
- A systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
- Data was sourced from Embase.com, with no restrictions on language or publication type.
- The random-effect model was employed to pool risk ratios (RR) and 95% confidence intervals (CI).
Main Results:
- Four trials with 340 patients were included.
- Cilostazol significantly reduced symptomatic vasospasm (RR=0.47), severe vasospasm (RR=0.48), and vasospasm-related cerebral infarctions (RR=0.38).
- Poor outcomes were also significantly lower in the cilostazol group (RR=0.57), with low numbers needed to treat.
Conclusions:
- Cilostazol demonstrates significant efficacy in reducing the incidence of symptomatic vasospasm, severe vasospasm, and associated cerebral infarctions after aneurysmal SAH.
- The drug also improves patient outcomes, reducing the likelihood of poor functional status.
- No significant difference in mortality rates was observed, and results showed no statistical heterogeneity.
Abstract:
Previous studies with small sample size have shown that cilostazol can reduce the risk of cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study was to determine whether cilostazol is effective in patients with aneurysmal SAH. Studies investigating the effect of cilostazol in patients with aneurysmal SAH were identified using Embase.com without language or publication-type restrictions. We used the random-effect model to combine data. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated. Two randomized controlled trials and two quasi-randomized controlled trials with a total of 340 patients were included. The incidence of symptomatic vasospasm (RR=0.47; 95% CI, 0.31-0.72; p<0.001), severe vasospasm (RR=0.48; 95% CI, 0.28-0.82; p=0.007), vasospasm-related new cerebral infarctions (RR=0.38; 95% CI, 0.22-0.67; p=0.001), and poor outcome (RR=0.57; 95% CI, 0.37-0.88; p=0.011) were significantly lower in the cilostazol group. The numbers needed to treat for these outcomes were 6.4, 6.3, 5.7, and 5.4, respectively. Mortality rate differences between the two groups were insignificant. No statistical heterogeneity was found for all outcomes. These results show that cilostazol can decrease the incidence of symptomatic vasospasm, severe vasospasm, vasospasm-related new cerebral infarctions, and poor outcome in patients with aneurysmal SAH.
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