Role of Cilostazol in prevention of vasospasm following aneurysmal subarachnoid hemorrhage - A systematic review, meta-analysis and trial sequential analysis.

OBJECTIVE: Cerebral vasospasm (CV) is a common complication following aneurysmal SAH (aSAH). Many drugs have been tried to mitigate cerebral vasospasm and delayed cerebral ischemia (DCI). Cilostazol, a selective inhibitor of phosphodiesterase 3, is a promising agent in preventing CV and DCI following aSAH. The objective of this article was to ascertain the effect of cilostazol on cerebral vasospasm following aSAH by performing meta-analysis and trial sequential analysis (TSA). METHODS: A systematic search of the literature was performed, and all the eligible randomized controlled trials were included in the meta-analysis and TSA. RESULTS: A total of 454 articles were identified using the search criteria. Six articles were selected for systematic review and the 4 RCTs were included in the meta-analysis. The pooled odds ratio for symptomatic vasospasm, new onset infarct and angiographic vasospasm was 0.35 (95% CI 0.21 to 0.59, p value <0.0001), 0.38 (95% CI 0.21 to 0.66, p value =0.0007) and (95% CI 0.31 to 0.80, p value =0.004) respectively. The pooled risk ratio for unfavorable outcome was 0.52 (95% CI 0.37 to 0.74, p value 0.0003). CONCLUSION: Cilostazol decreases the prevalence of symptomatic vasospasm, new onset infarct and angiographic vasospasm when administered after aneurysmal subarachnoid hemorrhage. Trial sequential analysis increased the precision of our results as the defined thresholds of effect were met by the available studies. However, further studies involving patients from other geographic areas are required to confirm the generalization of the results.