Antiplatelet Therapy and Outcomes after Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis

The efficacy of antiplatelet therapy (APT) after aneurysmal subarachnoid hemorrhage (aSAH) remains unclear. We performed a systematic review and meta-analysis to summarize the associations of APT use after aSAH with outcomes. We searched published medical literature to identify cohort studies involv...

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Bibliographic Details
Published in:Clinical neurology and neurosurgery 2023-12, Vol.235, p.108025-108025, Article 108025
Main Authors: Garton, Andrew L.A., Berger, Karen, Merkler, Alexander E., Kamel, Hooman, Knopman, Jared, Zhang, Cenai, Murthy, Santosh B.
Format: Article
Language:English
Subjects:
Adult
Aneurysm
Aneurysms
antiplatelet therapy
Aspirin
Bias
Brain Ischemia - complications
Brain Ischemia - drug therapy
Cerebral Infarction - complications
Clopidogrel
Cohort Studies
Confidence intervals
delayed cerebral infarction
disability
Hemorrhage
Humans
intracranial aneurysm
Ischemia
Meta-analysis
Neuroimaging
Platelet Aggregation Inhibitors - therapeutic use
Stroke
Subarachnoid hemorrhage
Subarachnoid Hemorrhage - complications
Subarachnoid Hemorrhage - diagnostic imaging
Subarachnoid Hemorrhage - drug therapy
Systematic review
Ticlopidine
Treatment Outcome
Vasospasm, Intracranial - drug therapy
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Description
Summary:The efficacy of antiplatelet therapy (APT) after aneurysmal subarachnoid hemorrhage (aSAH) remains unclear. We performed a systematic review and meta-analysis to summarize the associations of APT use after aSAH with outcomes. We searched published medical literature to identify cohort studies involving adults with aSAH. The exposure was APT use after aSAH. Outcome measures were good functional outcome (modified Rankin Score 0-2 or Glasgow Outcome Scale 4-5), delayed cerebral ischemia (infarcts on neuroimaging), and intracranial hemorrhage. After assessing study heterogeneity and publication bias, we performed a meta-analysis using random-effects models to assess the strength of association between APT and SAH outcomes. A total of 14 studies with 4,228 aSAH patients were included. APT after aSAH was associated with good functional outcome (pooled relative risk, 1.08; 95% confidence interval, [CI], 1.02-1.15; I2 = 45%, p for heterogeneity = 0.04), but there was no relationship with delayed cerebral ischemia (pooled relative risk, 0.80; 95% confidence interval, [CI], 0.63-1.02; I2 = 61%, p for heterogeneity
ISSN:0303-8467
1872-6968
1872-6968
DOI:10.1016/j.clineuro.2023.108025