Antiplatelet therapy in aneurysmal subarachnoid hemorrhage: a systematic review.
OBJECTIVE
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.
Dorhout Mees
Sanne M
SM
Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, Utrecht, the Netherlands.
Rinkel
Gabriel J E
GJ
Hop
Jeannette W
JW
Algra
Ale
A
van Gijn
Jan
J
D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012306:Risk; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors