<![CDATA[Ischemic stroke remains a major contributor to global mortality and long-term disability, with antiplatelet therapy representing a fundamental strategy for secondary prevention. Cilostazol and clopidogrel are widely utilized antiplatelet agents; however, existing comparative evidence on their safety and efficacy, particularly regarding bleeding risk, stroke recurrence, and mortality, is inconsistent. This systematic review and meta-analysis aim to evaluate and compare the efficacy and safety of cilostazol versus clopidogrel in patients with ischemic stroke. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted a comprehensive literature search across PubMed, Scopus, and Google Scholar up to September 2025. Eligible studies included randomized controlled trials and retrospective cohort studies directly comparing cilostazol and clopidogrel in adult patients with ischemic stroke. Multiple reviewers independently extracted data and selected studies using Covidence software to ensure consistency. We assessed risk of bias using the RoB 2.0 and ROBINS-I tools. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using Mantel–Haenszel methods. Eight studies comprising 8,249 participants were included in the analysis. Cilostazol was associated with lower risks of hemorrhagic complications (RR 0.77; 95% CI: 0.58–1.03) and mortality (RR 0.86; 95% CI: 0.70–1.04), although neither difference was statistically significant. No significant differences were identified between cilostazol and clopidogrel in recurrent ischemic stroke events or functional outcomes. Overall, both agents demonstrated comparable efficacy and safety profiles, supporting individualized treatment decisions based on clinical characteristics, bleeding risk, and comorbidities.]]>
