PICASSO sub‐group 2020.

Study characteristics
Methods	Design: randomised controlled, 2 × 2 factorial parallel group trial Setting: multicentre, 67 hospitals in three Asian countries Dates: 1 August 2009 to 31 August 2015
Participants	Sample size: 1534 participants overall (288 with prior ICH in the subgroup analysis included in this meta‐analysis) Diagnosis: non‐cardioembolic ischaemic stroke or transient ischaemic attack within 180 days and clinical history of prior ICH Inclusion criteria Age > 20 years Non‐cardioembolic ischaemic stroke or transient ischaemic attack within 180 days before study entry History of ICH defined as clinical or radiological findings or the presence of multiple (two or more) cerebral microbleeds, or asymptomatic ICH found incidentally as a slit‐like curvilinear lesion on MRI, without an overt history of ICH Exclusion criteria ICH within 6 months before study entry Presence of contraindications for long‐term use of an antiplatelet drug Presence of severe cardiomyopathy or congestive heart failure Occurrence of myocardial infarction or a coronary artery procedure within 4 weeks before screening Age (years, mean (SD)): unknown for this subgroup with prior ICH Sex: unknown for this subgroup with prior ICH
Interventions	Intervention: cilostazol 100 mg orally twice daily (matching the comparator) Comparator: aspirin 100 mg orally once daily (matching the intervention)
Outcomes	Primary outcomes The efficacy outcome was defined as time to first occurrence of a composite of major vascular events, including stroke, myocardial infarction, and vascular death The safety outcome was defined as time to first occurrence of ICH, which included spontaneous ICH and SAH, confirmed with CT or MRI Secondary outcomes Stroke Ischaemic stroke Myocardial infarction Other predefined vascular events Cardiovascular death and all‐cause mortality were also assessed during follow‐up as predefined tertiary outcomes Duration of follow‐up: at least 12 months.
Notes	Declarations of interest: SUK declares grants from Korea Otsuka Pharmaceutical Company. All other authors declare no competing interests Sources of funding: Korea Otsuka Pharmaceutical Company
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Interactive web‐based system. each participant received a subject number generated by the computer of the central randomisation service and was randomly assigned (1:1:1:1) to receive cilostazol (with aspirin placebo), aspirin (with cilostazol placebo), cilostazol plus probucol (with aspirin placebo), or aspirin plus probucol (with cilostazol placebo) using centralised blocks (block size 4) stratified by centre
Allocation concealment (selection bias)	Low risk	The analysis of cilostazol versus aspirin (antiplatelet arm) was double‐blinded, and the interactive web response system was used
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Cilostazol, aspirin, and placebos—used as a double dummy—were provided every 3 months in boxes within sealed opaque envelopes, with instructions to be taken twice a day
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Investigators were blinded
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Not mentioned
Selective reporting (reporting bias)	High risk	Not all were reported