Benefits and risks of antiplatelet therapy after bypass surgery for moyamoya disease: A meta-analysis

Bypass surgery is a leading treatment strategy for moyamoya disease. Antiplatelet therapy (APT) has the potential to prevent thrombosis and possibly enhance bypass graft patency. However, the efficacy and safety of APT following bypass surgery remain debatable. This study aims to assess the clinical outcomes of APT after bypass surgery.

A systematic review was conducted to evaluate the impact and associated complications of APT after bypass surgery. Electronic databases, including PubMed, Embase, and the Cochrane Library, were searched from their inception to September 1, 2023. The primary outcome was bypass patency.

This meta-analysis included five articles, encompassing 480 patients who underwent APT post-surgery and 423 patients who did not receive APT. Statistical analysis revealed that APT significantly increased bypass vessel patency (Odds Ratio [OR] 2.58; 95 % Confidence Interval [CI] 1.51-4.43; P = 0.0006), decreased the likelihood of transient cerebral ischemic events (OR 0.55; 95 % CI 0.32-0.95; P = 0.03), and enhanced patient functional outcomes (OR 1.88; 95 % CI 1.29-2.74; P = 0.001). However, no substantial differences were observed in postoperative stroke risk (OR 0.89; 95 % CI 0.49-1.63; P = 0.72), seizures (OR 1.43; 95 % CI 0.61-3.37; P = 0.41), or cerebral hemorrhage (OR 0.69; 95 % CI 0.28-1.71; P = 0.42) between the two groups.

The current evidence indicates that APT after bypass surgery enhances bypass vessel patency, reduces the risk of transient cerebral ischemic events, and improves functional outcomes in patients. However, it does not decrease the incidence of postoperative stroke and does not elevate the risks of cerebral hemorrhage and seizures.