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

Abstract

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.

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Acknowledgements

Study was funded by the “1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University” (No. ZY2016102), and National Natural Science Foundation of China (No. 81501003). We are grateful to Dr. Zhong Yao for his work in the early literature screening.

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Correspondence to Chao You or Xiaoqi Xie.

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I would like to declare on behalf of my co-authors that the work described was original research that has not been published previously, and not under the consideration for publication elsewhere, in whole or in part. In addition, no conflict of interest exists in our study. This article is a meta-analysis with all analyses based on previous published studies, thus no ethical approval and patient consent are required.

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Shan, T., Zhang, T., Qian, W. et al. Effectiveness and feasibility of cilostazol in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. J Neurol 267, 1577–1584 (2020). https://doi.org/10.1007/s00415-019-09198-z

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Keywords

  • Cilostazol
  • Aneurysm
  • Subarachnoid hemorrhage
  • Treatment
  • Meta-analysis