BACKGROUND AND PURPOSE: Observational studies suggest that platelet inhibitors reduce the risk of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage and thereby have a beneficial effect on clinical outcome. Robust evidence, however, is lacking. We performed a systematic meta-analysis to determine whether antiplatelet therapy has a beneficial effect after SAH. METHODS: We searched Medline and the Cochrane Library to identify all randomized controlled trials of antiplatelet drugs versus control and calculated relative risks with corresponding 95% confidence intervals (CIs) for poor outcome (dependence or death), the occurrence of DCI, and the occurrence of any intracranial hemorrhage. RESULTS: We included 5 trials totaling 699 patients. The overall relative risk for poor outcome was 0.87 (95% CI, 0.65 to 1.17); for the occurrence of DCI (reported in 3 of the 5 studies), 0.65 (95% CI, 0.47 to 0.89); and for the occurrence of intracranial hemorrhage, 1.19 (reported in 4 of the 5 studies) (95% CI, 0.76 to 1.85). CONCLUSIONS: Our data indicate that antiplatelet drugs reduce the risk of DCI in patients with subarachnoid hemorrhage. A randomized clinical trial is warranted to assess the effect on overall outcome.
BACKGROUND AND PURPOSE: Observational studies suggest that platelet inhibitors reduce the risk of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage and thereby have a beneficial effect on clinical outcome. Robust evidence, however, is lacking. We performed a systematic meta-analysis to determine whether antiplatelet therapy has a beneficial effect after SAH. METHODS: We searched Medline and the Cochrane Library to identify all randomized controlled trials of antiplatelet drugs versus control and calculated relative risks with corresponding 95% confidence intervals (CIs) for poor outcome (dependence or death), the occurrence of DCI, and the occurrence of any intracranial hemorrhage. RESULTS: We included 5 trials totaling 699 patients. The overall relative risk for poor outcome was 0.87 (95% CI, 0.65 to 1.17); for the occurrence of DCI (reported in 3 of the 5 studies), 0.65 (95% CI, 0.47 to 0.89); and for the occurrence of intracranial hemorrhage, 1.19 (reported in 4 of the 5 studies) (95% CI, 0.76 to 1.85). CONCLUSIONS: Our data indicate that antiplatelet drugs reduce the risk of DCI in patients with subarachnoid hemorrhage. A randomized clinical trial is warranted to assess the effect on overall outcome.
Authors: Jennifer A Frontera; J Javier Provencio; Fatima A Sehba; Thomas M McIntyre; Amy S Nowacki; Errol Gordon; Jonathan M Weimer; Louis Aledort Journal: Neurocrit Care Date: 2017-02 Impact factor: 3.210
Authors: F Cagnazzo; I Derraz; P-H Lefevre; G Gascou; C Dargazanli; C Riquelme; P Perrini; D di Carlo; A Bonafe; V Costalat Journal: AJNR Am J Neuroradiol Date: 2019-06-06 Impact factor: 3.825
Authors: Robert D Stevens; Neeraj S Naval; Marek A Mirski; Giuseppe Citerio; Peter J Andrews Journal: Intensive Care Med Date: 2009-06-17 Impact factor: 17.440
Authors: Antti Lindgren; Mervyn DI Vergouwen; Irene van der Schaaf; Ale Algra; Marieke Wermer; Mike J Clarke; Gabriel Je Rinkel Journal: Cochrane Database Syst Rev Date: 2018-08-15