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Published on: October 15, 2021

Prior antiplatelet therapy and outcome following intracerebral hemorrhage: a systematic review

B B Thompson1, Y Béjot, V Caso

  • 1Department of Neurology, Brown University, Providence, RI, USA.

Neurology
|September 10, 2010
PubMed

Insights

Antiplatelet therapy (APT) use before intracerebral hemorrhage (ICH) is linked to higher mortality. However, this study found no significant association between pre-ICH APT use and poor functional outcomes after accounting for other factors.

Area of Science:

  • Neurology
  • Clinical Trials
  • Public Health

Background:

  • Antiplatelet therapy (APT) is crucial for preventing thrombotic events but can increase bleeding risk.
  • Intracerebral hemorrhage (ICH) is a severe condition where bleeding occurs within the brain parenchyma.
  • The impact of pre-existing APT on ICH outcomes remains a critical clinical question.

Purpose of the Study:

  • To systematically review and meta-analyze existing cohort studies.
  • To investigate the association between pre-ICH APT use and mortality.
  • To assess the relationship between pre-ICH APT use and poor functional outcome after ICH.

Main Methods:

  • Systematic search of Medline and Embase databases for English-language human cohort studies.
  • Inclusion of studies reporting mortality or functional outcome in ICH patients based on pre-ICH APT use.
  • Pooled analysis of univariate and multivariable-adjusted odds ratios from 25 cohorts for mortality and 21 cohorts for functional outcome, including solicited unpublished data.

Main Results:

  • Pre-ICH APT use was associated with increased mortality in both univariate (OR 1.41) and multivariable-adjusted (OR 1.27) analyses.
  • The association between pre-ICH APT use and poor functional outcome was not significant in multivariable-adjusted analyses (OR 1.10).
  • Data were obtained from 25 cohorts for mortality and 21 cohorts for functional outcome, incorporating 15 and 14 unpublished studies, respectively.

Conclusions:

  • Pre-ICH APT use is independently associated with increased mortality in patients with intracerebral hemorrhage.
  • No independent association was found between pre-ICH APT use and poor functional outcome.
  • Findings highlight the complex risk-benefit balance of APT in patients who subsequently experience ICH.
Abstract

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