Effectiveness and feasibility of cilostazol in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

• Published in: Journal of neurology Vol. 267; no. 6; pp. 1577 - 1584
• Main Authors: Shan, Tikun, Zhang, Tiejun, Qian, Weiqiang, Ma, Lu, Li, Hao, You, Chao, Xie, Xiaoqi
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2020; Springer Nature B.V
• Subjects: Aneurysm; Aneurysms; Brain Ischemia - drug therapy; Brain Ischemia - etiology; Cardiovascular Agents - pharmacology; Cerebral infarction; Cerebral Infarction - drug therapy; Cerebral Infarction - etiology; Cilostazol - pharmacology; Clinical trials; Hemorrhage; Humans; Intracranial Aneurysm - complications; Intracranial Aneurysm - drug therapy; Ischemia; Medicine; Medicine & Public Health; Meta-analysis; Mortality; Neurology; Neuroradiology; Neurosciences; Nimodipine; Outcome Assessment, Health Care; Quality control; Review; Sensitivity analysis; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - complications; Subarachnoid Hemorrhage - drug therapy; Subarachnoid Hemorrhage - etiology; Systematic review; Vasoconstriction; Vasospasm, Intracranial - drug therapy; Vasospasm, Intracranial - etiology; Cilostazol; Treatment; Subarachnoid hemorrhage; Aneurysm; Meta-analysis
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-019-09198-z

Background Delayed cerebral ischemia seriously affects the prognosis of patients surviving the initial aneurysmal subarachnoid hemorrhage. Application of cilostazol was reported to ameliorate vasospasm and improve outcomes in series and clinical trials. But the effectiveness and feasibility of cilostazol on aneurysmal subarachnoid hemorrhage remained controversial. We performed a systematic review to clarify this issue. Methods PubMed, Ovid and Cochrane library database were systematically searched up to May 2018 for eligible publications in English. Quality assessment was conducted for included studies. Meta-analysis was conducted to evaluate the overall effect on events of interest. Subgroup analyses and sensitivity analyses were used to check whether the results were robust. Publication bias was evaluated with the funnel plot. Results Pooled analyses found cilostazol significantly reduced incidences of severe angiographic vasospasm ( p  = 0.0001), symptomatic vasospasm ( p  < 0.00001), new cerebral infarction ( p  < 0.00001) and the poor outcome ( p  < 0.0001). Subgroup and sensitivity analyses achieved consistent results. There was no statistical difference between cilostazol and the control group in reducing mortality ( p  = 0.07). But sensitivity analysis changed the result after excluding one study. Under the prescribed dosage, complication was few and non-lethal. Conclusions Cilostazol was effective and safe to reduce incidences of severe angiographic vasospasm, symptomatic vasospasm, new cerebral infarction and poor outcome in patients after aneurysmal subarachnoid hemorrhage. However, its effect on mortality and the interactive effect with nimodipine warranted further research.