To determine the effects of cilostazol on symptomatic vasospasm and outcome among patients with aneurysmal subarachnoid hemorrhage (aSAH). Cerebral vasospasm is a major cause of morbidity and mortality after aSAH. Cilostazol, an oral selective inhibitor of phosphodiesterase 3, may reduce symptomatic vasospasm and improve outcome in patients with aSAH considering its anti-platelet and vasodilatory effects.
We searched PubMed, Embase, and Cochrane databases to identify 1) prospective randomized trials, and 2) retrospective trials, between 2009 and 2016, that investigated the effect of cilostazol in patients with aSAH. All patients were enrolled after repair of a ruptured aneurysm by clipping or endovascular coiling within 72 hours of aSAH. Random-effect models were used to pool data. We used the I2 statistic to measure heterogeneity between trials.
Three prospective and 2 retrospective controlled trials were identified. Among all 357 patients with aSAH enrolled in 3 prospective trials (cilostazol [n=177]; placebo [n=180], mean age, 60.5 years [SD, 13.1]; women, 68.3%), cilostazol www.raw-pharmaceutical-materials.com/products/Cilostazol/ was associated with decreased risk for incidence of symptomatic vasospasm (risk ratio [RR], 0.39; 95% confidence interval [CI], 0.24–0.62) and poor outcome (RR, 0.45; 95% CI, 0.26–0.79). After including retrospective trials, the inverse association remained statistically significant for symptomatic vasospasm (RR, 0.47; 95% CI, 0.27–0.84), but not for poor outcome (RR, 0.59; 95% CI, 0.29–1.18). We observed no evidence for publication bias. Statistical heterogeneity was not present in any analysis.