الفهرس 
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Abstract
According to the World Health Organization, 15 million people suffer
stroke worldwide each year. Of these, 5 million die and another 5 million are
permanently disabled. About 88% of these strokes are ischemic and 8% to
12% of ischemic strokes result in death within 30 days. Despite gradual
declines in overall stroke death rates in many industrialized countries, stroke
remains a leading cause of death and disability worldwide. Stroke mortality is
particularly high in Eastern Europe and Asia.
Antiplatelet therapy is a major strategy for preventing recurrent
vascular events in patients with stroke or TIA of noncardioembolic etiology:
in their present clinical practice guidelines, the American Heart Association,
the American Stroke Association, the American College of Chest Physicians,
and the American Academy of Neurology acknowledge the benefits of aspirin
as well as prescription antiplatelet agents for secondary stroke prevention.
These organizations assert that aspirin (50 to 325 mg/d), the combination of
aspirin and extended-release dipyridamole or clopidogrel are all acceptable
options for initial therapy.
Aspirin is the most widely used antiplatelet agent for the prevention of
recurrent stroke because of its low cost and acceptable adverse-effect profile.
The effect of aspirin is small, however, because it prevents only about 13% to
22% of recurrent vascular events and only about 15% of recurrent stroke,
independent of dose. The findings of the European Stroke Prevention Study 2
(ESPS-2) showed that, compared with aspirin, the combination of aspirin plus extended-release dipyridamole was 23% more effective than aspirin
monotherapy in preventing subsequent stroke. Dual antiplatelet therapy
(DAPT) with aspirin and clopidogrel in comparison to aspirin monotherapy
reduced the relative risk of total stroke by 20% and of ischemic stroke or
transient ischemic attack by 23% according to charISMA trial.
Cilostazol is a phosphodiesterase type 3 with direct antiplatelet effect
and vasodilator effect. It has been used in treatment of peripheral vascular
disease. A meta-analysis that compared aspirin to cilostazol in stroke proved
cilostazol superiority.
This is the first meta-analysis to discuss the combination of aspirin plus
cilostazol in the secondary prevention of acute ischemic stroke. Our metaanalysis
proved that a combination of cilostazol and aspirin is more effective
regarding stroke recurrence and proved its safety compared with aspirin alone.