Skip to main content
Log in

Clinical Efficacy and Safety of Cilostazol: A Critical Review of the Literature

  • Review Article
  • Published:
Drugs Aims and scope Submit manuscript

Abstract

Cilostazol is a unique antiplatelet agent that has been commercially available for over two decades. As a phosphodiesterase III inhibitor, it reversibly inhibits platelet aggregation yet also possesses vasodilatory and antiproliferative properties. It has been widely studied in a variety of disease states, including peripheral arterial disease, cerebrovascular disease, and coronary artery disease with percutaneous coronary intervention. Overall, cilostazol appears to be a promising agent in the management of these disease states with a bleeding profile comparable to placebo; even when combined with other antiplatelet agents, cilostazol does not appear to increase the rate of bleeding. Despite the possible benefit of cilostazol, its use is limited by tolerability as some patients often report drug discontinuation due to headache, diarrhea, dizziness, or increased heart rate. To date, it has been predominantly studied in the Asian population, making it difficult to extrapolate these results to a more diverse patient population. This paper discusses the evolving role of cilostazol in the treatment of vascular diseases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Gresele P, Momi S, Falcinelli E. Anti-platelet therapy: phosphodiesterase inhibitors. Br J Clin Pharmacol. 2011;72(4):634–46. doi:10.1111/j.1365-2125.2011.04034.x.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Si Hayashi, Morishita R, Matsushita H, Nakagami H, Taniyama Y, Nakamura T, et al. Cyclic AMP inhibited proliferation of human aortic vascular smooth muscle cells, accompanied by induction of p53 and p21. Hypertension. 2000;35(1):237–43. doi:10.1161/01.hyp.35.1.237.

    Article  Google Scholar 

  3. Package Insert. Pletal (cilostazol). Rockville: Otsuka America Pharmaceutical, Inc.

  4. Pan XAE, Krzanowski JJ, Fitzpatrick DF, Polson JB. Synergistic interactions between selective pharmacological inhibitors of phosphidesterase isozyme families PDE III and PDE IV to attenuate proliferation of rat vascular smooth muscle cells. Biochem Pharmacol. 1994;48:827–35. doi:10.1016/0006-2952(94)90062-0.

    Article  CAS  PubMed  Google Scholar 

  5. Schror K. The pharmacology of cilostazol. Diabetes Obes Metab. 2002;4(Suppl. 2):S14–9.

    Article  CAS  PubMed  Google Scholar 

  6. Shin ES, Lee JH, Yoo SY, Park Y, Hong YJ, Kim MH, et al. A randomised, multicentre, double blind, placebo controlled trial to evaluate the efficacy and safety of cilostazol in patients with vasospastic angina. Heart (British Cardiac Society). 2014;100(19):1531–6. doi:10.1136/heartjnl-2014-305986.

    CAS  Google Scholar 

  7. Park SWLC, Kim HS, et al. Comparison of cilostazol versus ticlopidine threapy after stent implantation. Am J Cardiol. 1999;84:511–4. doi:10.1016/S0002-9149(99)00368-9.

    Article  CAS  PubMed  Google Scholar 

  8. Lee SW, Park SW, Hong MK, Lee CW, Kim YH, Park JH, et al. Comparison of cilostazol and clopidogrel after successful coronary stenting. Am J Cardiol. 2005;95(7):859–62. doi:10.1016/j.amjcard.2004.12.012.

    Article  CAS  PubMed  Google Scholar 

  9. Hashiguchi MOK, Nakazawa R, Kishino S, Mochizuki M, Shiga T. Comparison of cilostazol and ticlopodine for one-month effectiveness and safety after elective coronary stenting. Cardiovasc Drugs Ther. 2004;18:211–7. doi:10.1023/B:CARD.0000033642.49162.04.

    Article  CAS  PubMed  Google Scholar 

  10. Kubota YKK, Uchida H, et al. Pharmacologic treatment of intimal hyperplasia after metallic stent placement in the peripheral arteries: an experimental study. Invest Radiol. 1995;30:532–7.

    Article  CAS  PubMed  Google Scholar 

  11. Lee SW, Park SW, Kim YH, Yun SC, Park DW, Lee CW, et al. Comparison of triple versus dual antiplatelet therapy after drug-eluting stent implantation (from the DECLARE-Long trial). Am J Cardiol. 2007;100(7):1103–8. doi:10.1016/j.amjcard.2007.05.032.

    Article  CAS  PubMed  Google Scholar 

  12. Tsuchikane E, Fukuhara A, Kobayashi T, et al. Impact of cilostazol on restenosis after percutaneous coronary balloon angioplasty. Circulation. 1999;100(1):21–6. doi:10.1161/01.CIR.100.1.21.

    Article  CAS  PubMed  Google Scholar 

  13. Park SWLC, Kim HS, et al. Effects of cilostazol on angiographic restenosis after coronary stent placement. Am J Cardiol. 2000;86:499–503. doi:10.1016/S0002-9149(00)01001-8.

    Article  CAS  PubMed  Google Scholar 

  14. Douglas JS Jr, Holmes DR Jr, Kereiakes DJ, Grines CL, Block E, Ghazzal ZM, et al. Coronary stent restenosis in patients treated with cilostazol. Circulation. 2005;112(18):2826–32. doi:10.1161/CIRCULATIONAHA.104.530097.

    Article  CAS  PubMed  Google Scholar 

  15. Liu Y, Fong M, Cone J, Wang S, Yoshitake M, Kambayashi J. Inhibition of adenosine uptake and augmentation of ischemia-induced increase of interstitial adenosine by cilostazol, an agent to treat intermittent claudication. J Cardiovasc Pharmacol. 2000;36(3):351–60.

    Article  CAS  PubMed  Google Scholar 

  16. Schror K. The pharmacology of cilostazol. Diabetes Obes Metab. 2002;2:S14–9. doi:10.1046/j.1463.2002.0040s2s14.x.

    Article  Google Scholar 

  17. Elam MBHJ, Crouse JR, et al. Effect of the novel antiplatelet agent cilostazol on plasma lipoproteins in patients with intermittent claudication. Arterioscler Thromb Vasc Biol. 1998;18:1942–7.

    Article  CAS  PubMed  Google Scholar 

  18. Park KW, Park JJ, Lee SP, Oh IY, Suh JW, Yang HM, et al. Cilostazol attenuates on-treatment platelet reactivity in patients with CYP2C19 loss of function alleles receiving dual antiplatelet therapy: a genetic substudy of the CILON-T randomised controlled trial. Heart (British Cardiac Society). 2011;97(8):641–7. doi:10.1136/hrt.2010.216499.

    Article  CAS  Google Scholar 

  19. Lee SW, Park SW, Yun SC, Kim YH, Park DW, Kim WJ, et al. Triple antiplatelet therapy reduces ischemic events after drug-eluting stent implantation: Drug-Eluting stenting followed by Cilostazol treatment REduces Adverse Serious cardiac Events (DECREASE registry). Am Heart J. 2010;159(2):284–291 e1. doi:10.1016/j.ahj.2009.11.014.

    Article  CAS  PubMed  Google Scholar 

  20. Chen KY, Rha SW, Li YJ, Poddar KL, Jin Z, Minami Y, et al. Triple versus dual antiplatelet therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Circulation. 2009;119(25):3207–14. doi:10.1161/CIRCULATIONAHA.108.822791.

    Article  CAS  PubMed  Google Scholar 

  21. Anderson JL, Halperin JL, Albert N, Bozkurt B, Brindis RG, Curtis LH, et al. Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(14):1555–70. doi:10.1016/j.jacc.2013.01.004.

    Article  Google Scholar 

  22. Alonso-Coello P, Bellmunt S, McGorrian C, Anand SS, Guzman R, Criqui MH, et al. Antithrombotic therapy in peripheral artery disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e669S–90S. doi:10.1378/chest.11-2307.

    PubMed Central  CAS  PubMed  Google Scholar 

  23. Robless P, Mikhailidis DP, Stansby GP. Cilostazol for peripheral arterial disease. Cochrane Database Syst Rev. 2008;1:CD003748. doi:10.1002/14651858.CD003748.pub3.

    PubMed  Google Scholar 

  24. Iida O, Nanto S, Uematsu M, Morozumi T, Kitakaze M, Nagata S. Cilostazol reduces restenosis after endovascular therapy in patients with femoropopliteal lesions. J Vasc Surg. 2008;48(1):144–9. doi:10.1016/j.jvs.2008.02.062.

    Article  PubMed  Google Scholar 

  25. Iida O, Yokoi H, Soga Y, Inoue N, Suzuki K, Yokoi Y, et al. Cilostazol reduces angiographic restenosis after endovascular therapy for femoropopliteal lesions in the sufficient treatment of peripheral intervention by cilostazol study. Circulation. 2013;127(23):2307–15. doi:10.1161/CIRCULATIONAHA.112.000711.

    Article  CAS  PubMed  Google Scholar 

  26. Ishii H, Kumada Y, Toriyama T, Aoyama T, Takahashi H, Yamada S, et al. Cilostazol improves long-term patency after percutaneous transluminal angioplasty in hemodialysis patients with peripheral artery disease. Clin J Am Soc Nephrol. 2008;3(4):1034–40. doi:10.2215/CJN.05761207.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  27. Ishii H, Kumada Y, Toriyama T, Aoyama T, Takahashi H, Tanaka M, et al. Effects of oral cilostazol 100 mg BID on long-term patency after percutaneous transluminal angioplasty in patients with femoropopliteal disease undergoing hemodialysis: a retrospective chart review in Japanese patients. Clin Ther. 2010;32(1):24–33. doi:10.1016/j.clinthera.2010.01.007.

    Article  CAS  PubMed  Google Scholar 

  28. Soga Y, Yokoi H, Kawasaki T, Nakashima H, Tsurugida M, Hikichi Y, et al. Efficacy of cilostazol after endovascular therapy for femoropopliteal artery disease in patients with intermittent claudication. J Am Coll Cardiol. 2009;53(1):48–53. doi:10.1016/j.jacc.2008.09.020.

    Article  CAS  PubMed  Google Scholar 

  29. Squires H, Simpson E, Meng Y, Harnan S, Stevens J, Wong R, et al. A systematic review and economic evaluation of cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate for the treatment of intermittent claudication in people with peripheral arterial disease. Health Technol Assess. 2011;15(40):1–210. doi:10.3310/hta15400.

    Article  CAS  PubMed  Google Scholar 

  30. Bedenis R, Stewart M, Cleanthis M, Robless P, Mikhailidis DP, Stansby G. Cilostazol for intermittent claudication. Cochrane Database Syst Rev. 2014;10:CD003748. doi:10.1002/14651858.CD003748.pub4.

    PubMed  Google Scholar 

  31. Lund-Kordahl I, Olasveengen TM, Lorem T, Samdal M, Wik L, Sunde K. Improving outcome after out-of-hospital cardiac arrest by strengthening weak links of the local chain of survival; quality of advanced life support and post-resuscitation care. Resuscitation. 2010;81(4):422–6. doi:10.1016/j.resuscitation.2009.12.020.

    Article  PubMed  Google Scholar 

  32. European Medicines Agency recommends restricting use of cilostazol-containing medicines. 2013.

  33. Perez P, Esteban C, Sauquillo JC, Yeste M, Manzano L, Mujal A, et al. Cilostazol and outcome in outpatients with peripheral artery disease. Thromb Res. 2014;134(2):331–5. doi:10.1016/j.thromres.2014.05.040.

    Article  CAS  PubMed  Google Scholar 

  34. Hiatt WR, Money SR, Brass EP. Long-term safety of cilostazol in patients with peripheral artery disease: the CASTLE study (Cilostazol: A Study in Long-term Effects). J Vasc Surg. 2008;47(2):330–6. doi:10.1016/j.jvs.2007.10.009.

    Article  PubMed  Google Scholar 

  35. Adam DJ, Bradbury AW. TASC II document on the management of peripheral arterial disease. Eur J Vasc Endovasc Surg. 2007;33(1):1–2. doi:10.1016/j.ejvs.2006.11.008.

    Article  CAS  PubMed  Google Scholar 

  36. Spiliopoulos S, Pastromas G, Katsanos K, Kitrou P, Karnabatidis D, Siablis D. Platelet responsiveness to clopidogrel treatment after peripheral endovascular procedures: the PRECLOP study: clinical impact and optimal cutoff value of on-treatment high platelet reactivity. J Am Coll Cardiol. 2013;61(24):2428–34. doi:10.1016/j.jacc.2013.03.036.

    Article  CAS  PubMed  Google Scholar 

  37. European Stroke O, Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clement D, et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(22):2851–906. doi:10.1093/eurheartj/ehr211.

    Article  Google Scholar 

  38. Warner CJ, Greaves SW, Larson RJ, Stone DH, Powell RJ, Walsh DB, et al. Cilostazol is associated with improved outcomes after peripheral endovascular interventions. J Vasc Surg. 2014;59(6):1607–14. doi:10.1016/j.jvs.2013.11.096.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Iida O, Yokoi H, Soga Y, Inoue N, et al. Cilostazol reduces angiographic restenosis after endovascular therapy for femoropopliteal lesions in the sufficient treatment of peripheral intervention by Cilostazol study. STOP-IC. Circulation. 2013;127(23):2307–15.

    Article  CAS  PubMed  Google Scholar 

  40. Cacoub PP, Abola MT, Baumgartner I, Bhatt DL, Creager MA, Liau CS, et al. Cardiovascular risk factor control and outcomes in peripheral artery disease patients in the Reduction of Atherothrombosis for Continued Health (REACH) Registry. Atherosclerosis. 2009;204(2):e86–92. doi:10.1016/j.atherosclerosis.2008.10.023.

    Article  CAS  PubMed  Google Scholar 

  41. Azarbal A, Clavijo L, Gaglia MA Jr. Antiplatelet therapy for peripheral arterial disease and critical limb ischemia: guidelines abound, but where are the data? J Cardiovasc Pharmacol Ther. 2014;. doi:10.1177/1074248414545126.

    PubMed  Google Scholar 

  42. Soga Y, Iida O, Kawasaki D, Hirano K, Yamaoka T, Suzuki K. Impact of cilostazol on angiographic restenosis after balloon angioplasty for infrapopliteal artery disease in patients with critical limb ischemia. Eur J Vasc Endovasc Surg. 2012;44(6):577–81. doi:10.1016/j.ejvs.2012.09.020.

    Article  CAS  PubMed  Google Scholar 

  43. Angiolillo DJ. Variability in responsiveness to oral antiplatelet therapy. Am J Cardiol. 2009;103(3 Suppl):27a–34a. doi:10.1016/j.amjcard.2008.11.020.

    Article  CAS  PubMed  Google Scholar 

  44. Aradi D, Komocsi A, Vorobcsuk A, Rideg O, Tokes-Fuzesi M, Magyarlaki T, et al. Prognostic significance of high on-clopidogrel platelet reactivity after percutaneous coronary intervention: systematic review and meta-analysis. Am Heart J. 2010;160(3):543–51. doi:10.1016/j.ahj.2010.06.004.

    Article  CAS  PubMed  Google Scholar 

  45. Bonello L, Tantry US, Marcucci R, Blindt R, Angiolillo DJ, Becker R, et al. Consensus and future directions on the definition of high on-treatment platelet reactivity to adenosine diphosphate. J Am Coll Cardiol. 2010;56(12):919–33. doi:10.1016/j.jacc.2010.04.047.

    Article  CAS  PubMed  Google Scholar 

  46. Brar SS, ten Berg J, Marcucci R, Price MJ, Valgimigli M, Kim HS, et al. Impact of platelet reactivity on clinical outcomes after percutaneous coronary intervention. A collaborative meta-analysis of individual participant data. J Am Coll Cardiol. 2011;58(19):1945–54. doi:10.1016/j.jacc.2011.06.059.

    Article  PubMed  Google Scholar 

  47. Gurbel PA, Tantry US. Acceptance of high platelet reactivity as a risk factor: now, what do we do about it? JACC Cardiovasc Interv. 2010;3(10):1008–10. doi:10.1016/j.jcin.2010.08.011.

    Article  PubMed  Google Scholar 

  48. Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. NEJM. 2007;357(20):2001–15. doi:10.1056/NEJMoa0706482.

    Article  CAS  PubMed  Google Scholar 

  49. Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. NEJM. 2009;361(11):1045–57. doi:10.1056/NEJMoa0904327.

    Article  CAS  PubMed  Google Scholar 

  50. O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(4):e78–140. doi:10.1016/j.jacc.2012.11.019.

    Article  PubMed  Google Scholar 

  51. Amsterdam EA, Wenger NK, Brindis RG, Casey DE Jr, Ganiats TG, Holmes DR Jr, et al. AHA/ACC guideline for the management of patients with non-st-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;. doi:10.1016/j.jacc.2014.09.017.

    PubMed Central  Google Scholar 

  52. Jennings DL, Kalus JS. Addition of cilostazol to aspirin and a thienopyridine for prevention of restenosis after coronary artery stenting: a meta-analysis. J Clin Pharmacol. 2010;50(4):415–21. doi:10.1177/0091270009338940.

    Article  CAS  PubMed  Google Scholar 

  53. Rogers KC, Faircloth JM, Finks SW. Use of cilostazol in percutaneous coronary interventions. Ann Pharmacother. 2012;46(6):839–50. doi:10.1345/aph.1Q765.

    Article  PubMed  Google Scholar 

  54. Biondi-Zoccai GG, Lotrionte M, Anselmino M, Moretti C, Agostoni P, Testa L, et al. Systematic review and meta-analysis of randomized clinical trials appraising the impact of cilostazol after percutaneous coronary intervention. Am Heart J. 2008;155(6):1081–9. doi:10.1016/j.ahj.2007.12.024.

    Article  CAS  PubMed  Google Scholar 

  55. Jang JS, Jin HY, Seo JS, Yang TH, Kim DK, Kim DS, et al. A meta-analysis of randomized controlled trials appraising the efficacy and safety of cilostazol after coronary artery stent implantation. Cardiology. 2012;122(3):133–43. doi:10.1159/000339238.

    Article  CAS  PubMed  Google Scholar 

  56. Chen J, Meng H, Xu L, Liu J, Kong D, Chen P, et al. Efficacy and safety of cilostazol based triple antiplatelet treatment versus dual antiplatelet treatment in patients undergoing coronary stent implantation: an updated meta-analysis of the randomized controlled trials. J Thromb Thrombolysis. 2014;. doi:10.1007/s11239-014-1090-5.

    PubMed Central  Google Scholar 

  57. Bangalore S, Singh A, Toklu B, DiNicolantonio JJ, Croce K, Feit F, et al. Efficacy of cilostazol on platelet reactivity and cardiovascular outcomes in patients undergoing percutaneous coronary intervention: insights from a meta-analysis of randomised trials. Open Heart. 2014;1(1):e000068. doi:10.1136/openhrt-2014-000068.

    Article  PubMed Central  PubMed  Google Scholar 

  58. Price MJ, Berger PB, Teirstein PS, Tanguay JF, Angiolillo DJ, Spriggs D, et al. Standard- vs high-dose clopidogrel based on platelet function testing after percutaneous coronary intervention: the GRAVITAS randomized trial. JAMA. 2011;305(11):1097–105. doi:10.1001/jama.2011.290.

    Article  CAS  PubMed  Google Scholar 

  59. Collet JP, Cuisset T, Range G, Cayla G, Elhadad S, Pouillot C, et al. Bedside monitoring to adjust antiplatelet therapy for coronary stenting. NEJM. 2012;367(22):2100–9. doi:10.1056/NEJMoa1209979.

    Article  CAS  PubMed  Google Scholar 

  60. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2011;58(24):e44–122. doi:10.1016/j.jacc.2011.08.007.

    Article  PubMed  Google Scholar 

  61. Yang TH, Jin HY, Choi KN, Do U, Kim HJ, Chung SR, et al. Randomized comparison of new dual-antiplatelet therapy (aspirin, prasugrel) and triple-antiplatelet therapy (aspirin, clopidogrel, cilostazol) using P2Y12 point-of-care assay in patients with STEMI undergoing primary PCI. Int J Cardiol. 2013;168(1):207–11. doi:10.1016/j.ijcard.2012.09.093.

    Article  PubMed  Google Scholar 

  62. Park KH, Jeong MH, Lee KH, Sim DS, Yoon HJ, Yoon NS, et al. Comparison of peri-procedural platelet inhibition with prasugrel versus adjunctive cilostazol to dual anti-platelet therapy in patients with ST segment elevation myocardial infarction. J Cardiol. 2014;63(2):99–105. doi:10.1016/j.jjcc.2013.07.004.

    Article  PubMed  Google Scholar 

  63. Shuldiner AR, O’Connell JR, Bliden KP, Gandhi A, Ryan K, Horenstein RB, et al. Association of cytochrome P450 2C19 genotype with the antiplatelet effect and clinical efficacy of clopidogrel therapy. JAMA. 2009;302(8):849–57. doi:10.1001/jama.2009.1232.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  64. Holmes DR Jr, Dehmer GJ, Kaul S, Leifer D, O’Gara PT, Stein CM. ACCF/AHA clopidogrel clinical alert: approaches to the FDA “boxed warning”: a report of the American College of Cardiology Foundation Task Force on clinical expert consensus documents and the American Heart Association endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol. 2010;56(4):321–41. doi:10.1016/j.jacc.2010.05.013.

    Article  CAS  PubMed  Google Scholar 

  65. Park KW, Kang SH, Park JJ, Yang HM, Kang HJ, Koo BK, et al. Adjunctive cilostazol versus double-dose clopidogrel after drug-eluting stent implantation: the HOST-ASSURE randomized trial (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-Safety & Effectiveness of Drug-Eluting Stents & Anti-platelet Regimen). JACC Cardiovasc Interv. 2013;6(9):932–42. doi:10.1016/j.jcin.2013.04.022.

    Article  PubMed  Google Scholar 

  66. Centers for Disease C, Prevention. Racial/ethnic and socioeconomic disparities in multiple risk factors for heart disease and stroke–United States, 2003. MMWR Morb Mortal Wkly Rep. 2005;54(5):113–7.

    Google Scholar 

  67. Zhang LF, Yang J, Hong Z, Yuan GG, Zhou BF, Zhao LC, et al. Proportion of different subtypes of stroke in China. Stroke. 2003;34(9):2091–6. doi:10.1161/01.str.0000087149.42294.8c.

    Article  PubMed  Google Scholar 

  68. Jiang B, Wang WZ, Chen H, Hong Z, Yang QD, Wu SP, et al. Incidence and trends of stroke and its subtypes in China: results from three large cities. Stroke. 2006;37(1):63–8. doi:10.1161/01.str.0000194955.34820.78.

    Article  PubMed  Google Scholar 

  69. Yang QD, Niu Q, Zhou YH, Liu YH, Xu HW, Gu WP, et al. Incidence of cerebral hemorrhage in the Changsha community. A prospective study from 1986 to 2000. Cerebrovasc Dis. 2004;17(4):303–13. doi:10.1159/000077341.

    Article  PubMed  Google Scholar 

  70. Watanabe K, Nakase H, Kimura Y. Effect of cilostazol on experimental cerebral infarction in rabbits. Arzneimittelforschung. 1986;36(7):1022–4.

    CAS  PubMed  Google Scholar 

  71. Tanaka K, Gotoh F, Fukuuchi Y, Amano T, Uematsu D, Kawamura J, et al. Effects of a selective inhibitor of cyclic AMP phosphodiesterase on the pial microcirculation in feline cerebral ischemia. Stroke. 1989;20(5):668–73.

    Article  CAS  PubMed  Google Scholar 

  72. Gotoh F, Tohgi H, Hirai S, Terashi A, Fukuuchi Y, Otomo E, et al. Cilostazol stroke prevention study: a placebo-controlled double-blind trial for secondary prevention of cerebral infarction. J Stroke Cerebrovasc Dis. 2000;9(4):147–57. doi:10.1053/jscd.2000.7216.

    Article  CAS  PubMed  Google Scholar 

  73. Huang Y, Cheng Y, Wu J, Li Y, Xu E, Hong Z, et al. Cilostazol as an alternative to aspirin after ischaemic stroke: a randomised, double-blind, pilot study. Lancet Neurol. 2008;7(6):494–9. doi:10.1016/S1474-4422(08)70094-2.

    Article  CAS  PubMed  Google Scholar 

  74. Shinohara Y, Katayama Y, Uchiyama S, Yamaguchi T, Handa S, Matsuoka K, et al. Cilostazol for prevention of secondary stroke (CSPS 2): an aspirin-controlled, double-blind, randomised non-inferiority trial. Lancet Neurol. 2010;9(10):959–68. doi:10.1016/S1474-4422(10)70198-8.

    Article  CAS  PubMed  Google Scholar 

  75. Dinicolantonio JJ, Lavie CJ, Fares H, Menezes AR, O’Keefe JH, Bangalore S, et al. Meta-analysis of cilostazol versus aspirin for the secondary prevention of stroke. Am J Cardiol. 2013;112(8):1230–4. doi:10.1016/j.amjcard.2013.05.067.

    Article  CAS  PubMed  Google Scholar 

  76. Qian Y, Bi Q. Systematic study of cilostazol on secondary stroke prevention: a meta-analysis. Eur J Med Res. 2013;18:53. doi:10.1186/2047-783X-18-53.

    Article  PubMed Central  PubMed  Google Scholar 

  77. Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870–947. doi:10.1161/STR.0b013e318284056a.

    Article  PubMed  Google Scholar 

  78. Fujita K, Komatsu Y, Sato N, Higuchi O, Kujiraoka Y, Kamezaki T, et al. Pilot study of the safety of starting administration of low-dose aspirin and cilostazol in acute ischemic stroke. Neurol Med Chir (Tokyo). 2011;51(12):819–24.

    Article  PubMed  Google Scholar 

  79. Lee YS, Bae HJ, Kang DW, Lee SH, Yu K, Park JM, et al. Cilostazol in acute ischemic stroke treatment (CAIST Trial): a randomized double-blind non-inferiority trial. Cerebrovasc Dis. 2011;32(1):65–71. doi:10.1159/000327036.

    Article  CAS  PubMed  Google Scholar 

  80. Shimizu H, Tominaga T, Ogawa A, Kayama T, Mizoi K, Saito K, et al. Cilostazol for the prevention of acute progressing stroke: a multicenter, randomized controlled trial. J Stroke Cerebrovasc Dis. 2013;22(4):449–56. doi:10.1016/j.jstrokecerebrovasdis.2013.02.009.

    Article  PubMed  Google Scholar 

  81. Shinohara Y. Japanese guidelines for the management of stroke 2009: important revised points necessary for the neurologist. Rinsho Shinkeigaku. 2010;50(11):808–11.

    Article  PubMed  Google Scholar 

  82. European Stroke Organisation Executive C, Committee ESOW. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis. 2008;25(5):457–507. doi:10.1159/000131083.

    Article  Google Scholar 

  83. Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(7):2160–236. doi:10.1161/str.0000000000000024.

    Article  PubMed  Google Scholar 

  84. Soga Y, Iida O, Hirano K, Suzuki K, Yokoi H, Nobuyoshi M. Restenosis after stent implantation for superficial femoral artery disease in patients treated with cilostazol. Catheter Cardiovasc Interv. 2012;79(4):541–8. doi:10.1002/ccd.23304.

    Article  PubMed  Google Scholar 

  85. Ikushima I, Yonenaga K, Iwakiri H, Nagoshi H, Kumagai H, Yamashita Y. A better effect of cilostazol for reducing in-stent restenosis after femoropopliteal artery stent placement in comparison with ticlopidine. Med Devices. 2011;4:83–9. doi:10.2147/MDER.S21629.

    Article  CAS  Google Scholar 

Download references

Acknowledgments

No external funding was used for the preparation of this review article. None of the authors have any potential conflicts of interest that might be relevant to the content of this review article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kelly C. Rogers.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rogers, K.C., Oliphant, C.S. & Finks, S.W. Clinical Efficacy and Safety of Cilostazol: A Critical Review of the Literature. Drugs 75, 377–395 (2015). https://doi.org/10.1007/s40265-015-0364-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40265-015-0364-3

Keywords

Navigation