This study aims to determine which drug, cilostazol or aspirin, is most effective in preventing stroke episodes, contributing to the existing evidence on this topic.

Stroke is a leading cause of mortality and disability globally, and preventing recurrence presents a major clinical challenge. Among the available therapeutic options, antiplatelet agents play a crucial role. Recent studies have explored the effectiveness in preventing stroke recurrence by comparing Cilostazol and Aspirin, revealing conflicting findings.

PubMed, EMBASE, Cochrane Central and Web of Science databases were systematically searched for studies investigating the outcomes of using Cilostazol or Aspirin to prevent stroke occurrence. Study data were examined using the Mantel-Haenszel method and 95% CIs. Heterogeneity was assessed using I² statistics. Review Manager 5.1, was used for statistical analysis.

Of 1999 records identified, seven were eligible for inclusion. The pooled data provided 7242 patients, 3611 (49.,86%) of whom received Cilostazol and 3631 (50.,13%) received Aspirin. Compared with aspirin, cilostazol achieved better ischemic stroke prevention rates (3.,42% vs 5.,43%; odds ratio [OR] 0.62, 95% CI 0.47-0.81; P = 0.0004; I 2 = 0).
However, there were no significant differences in the rates of transient ischemic attack (3.17% vs 3.85%; OR 0.14; 95% CI 0.61-1.08; P=0.14; I²=0%) and intracerebral hemorrhage (0.51% vs 1.06%; OR 0.50; 95% CI 0.24-1.03; P=0.06; I²=0%).

Consistent with previous meta-analyses, this study demonstrates that Cilostazol is significantly more advantageous in preventing stroke events compared to the control group. These findings underscore the need to reassess treatment protocols, particularly regarding the routine use of Cilostazol as an alternative to Aspirin, especially in countries like Brazil where Aspirin is often preferred, to enhance patient outcomes.