Antiplatelet Resumption After Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

Area of Science:

• Neurology
• Cardiology
• Clinical Medicine

Background:

• Intracerebral hemorrhage (ICH) management is challenging due to the dual risk of recurrent bleeding with antiplatelet therapy and ischemic stroke upon discontinuation.
• Physicians exhibit hesitancy in early antiplatelet reinitiation post-ICH due to a lack of evidence-based guidelines.

Purpose of the Study:

• To assess the safety and efficacy of early antiplatelet therapy resumption following intracerebral hemorrhage through a meta-analysis.

Main Methods:

• Systematic review of Web of Science, Scopus, PubMed, and Cochrane Library up to April 2025.
• Inclusion of 10 studies (8 observational, 2 RCTs) involving 5554 adult patients with ICH surviving >24 hours.
• Statistical analysis using R software, pooling categorical outcomes as risk ratios (RRs) with 95% confidence intervals (CIs).

Main Results:

• Early antiplatelet therapy significantly reduced recurrent ICH by 46% (RR 0.54, 95% CI 0.37-0.78, p=0.001).
• No significant differences were observed in all-cause mortality (p=0.06), ischemic stroke (p=0.96), major hemorrhagic events (p=0.17), or ischemic vascular outcomes (p=0.60).

Conclusions:

• Early antiplatelet therapy following intracerebral hemorrhage is associated with a significant 46% reduction in recurrent hemorrhagic events.
• Resuming antiplatelet therapy early does not increase the risk of major ischemic or hemorrhagic complications, supporting its clinical consideration.