Antiplatelet Agents for the Secondary Prevention of Ischemic Stroke or Transient Ischemic Attack: A Network...

Area of Science:

• Neurology
• Cardiology
• Pharmacology

Background:

• Stroke, including ischemic stroke (IS) and transient ischemic attack (TIA), leads to significant morbidity and mortality.
• Patients with IS or TIA face a high risk of recurrent stroke, necessitating effective secondary prevention strategies.
• Antiplatelet agents are standard therapy, but optimal agent selection remains challenging for clinicians.

Purpose of the Study:

• To conduct a network meta-analysis evaluating the efficacy of antiplatelet agents for secondary stroke prevention.
• To compare the effectiveness of various antiplatelet therapies in reducing stroke recurrence and related complications.

Main Methods:

• Systematic literature search of PubMed, Embase, and Cochrane databases up to August 2015.
• Inclusion of 30 relevant trials for network meta-analysis.
• Primary endpoints included overall stroke, hemorrhagic stroke, and fatal stroke events.

Main Results:

• Cilostazol (Cilo) demonstrated significantly better outcomes for overall stroke and hemorrhagic stroke compared to aspirin (OR=0.64, 95% CrI: 0.45-0.91; OR=0.23, 95% CrI: 0.08-0.58).
• Cilo combined with aspirin showed the highest estimate for reducing fatal stroke, followed by Cilo monotherapy.
• Cilostazol proved significantly more effective in Asian patients compared to other evaluated therapies.

Conclusions:

• Cilostazol is effective in improving overall and hemorrhagic stroke outcomes and reducing fatal stroke in IS/TIA patients, though with low statistical significance for fatal stroke reduction.
• The findings suggest cilostazol as a beneficial agent for secondary stroke prevention.
• Future research should investigate cilostazol's efficacy in non-Asian populations for secondary stroke prevention.