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Effects of Prior Antiplatelet Therapy on the Prognosis of Primary Intracerebral Hemorrhage: A Meta-analysis
Hai-Han Yu1, Chao Pan1, Ying-Xin Tang1
1Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
Insights
Prior antiplatelet therapy (APT) increases mortality risk in patients with intracerebral hemorrhage (ICH). This risk is particularly significant in the early stages following ICH, highlighting the need for careful consideration of APT use.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Antiplatelet therapy (APT) is widely used for vascular disease prevention.
- The impact of prior APT on intracerebral hemorrhage (ICH) prognosis is debated.
- This study investigates the association between prior APT and outcomes in primary ICH patients.
Purpose of the Study:
- To conduct a meta-analysis exploring the effects of prior antiplatelet therapy on the prognosis of patients with primary intracerebral hemorrhage.
- To quantify the association between pre-existing antiplatelet therapy and mortality risk in ICH patients.
Main Methods:
- A systematic literature search was performed in PubMed and Embase.
- Twenty-two high-quality studies comparing mortality in ICH patients with and without prior APT were included.
- Newcastle-Ottawa quality assessment scale was used; pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated.
Main Results:
- Prior APT was associated with significantly increased mortality in ICH patients (OR=1.37, P=0.001 univariate; OR=1.41, P=0.024 multivariate).
- Meta-regression revealed that mortality risk in APT patients decreased over time (OR decreased by 0.0049 per day).
- The effect of APT on mortality was most pronounced in the early period after ICH.
Conclusions:
- Prior antiplatelet therapy is linked to higher mortality rates in patients experiencing intracerebral hemorrhage.
- The heightened mortality risk associated with prior APT appears to be primarily driven by its impact during the early phase of ICH.
- Findings suggest a need to re-evaluate the management of ICH patients on prior APT.
Background:
Antiplatelet therapy (APT) was prevalently being used in the prevention of vascular disease, but the influence of prior APT on the prognosis of patients with intracerebral hemorrhage (ICH) remains controversial. This meta-analysis was to explore the effects of prior APT on the prognosis of patients with primary ICH.
Methods:
PubMed and Embase were searched to identify the eligible studies. The studies comparing the mortality of ICH patients with or without prior APT were included. The quality of these studies was evaluated by the Newcastle-Ottawa quality assessment scale. The adjusted or unadjusted odds ratio (OR) for mortality between ICH patients with and without prior APT were pooled with 95% confidence interval (95% CI) as the effect of this meta-analysis.
Results:
Twenty-two studies fulfilled the inclusion criteria and exhibited high qualities. The pooled OR was 1.37 (95% CI: 1.13-1.66, P = 0.001) for univariate analysis and 1.41 (95% CI: 1.05-1.90, P = 0.024) for multivariate analysis. The meta-regression indicated that for each 1-day increase in the time of assessment, the adjusted OR for the mortality of APT patients decreased by 0.0049 (95% CI: 0.0006-0.0091, P = 0.026) as compared to non-APT patients.
Conclusion:
Prior APT was associated with high mortality in patients with ICH that might be attributed primarily to its strong effect on early time.
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