Prior antiplatelet therapy and outcome following intracerebral hemorrhage: a systematic review.
OBJECTIVE
Antiplatelet therapy (APT) promotes bleeding; therefore, APT might worsen outcome in patients with intracerebral hemorrhage (ICH). We performed a systematic review and meta-analysis to address the hypothesis that pre-ICH APT use is associated with mortality and poor functional outcome following ICH.


METHODS
The Medline and Embase databases were searched in February 2008 using relevant key words, limited to human studies in the English language. Cohort studies of consecutive patients with ICH reporting mortality or functional outcome according to pre-ICH APT use were identified. Of 2,873 studies screened, 10 were judged to meet inclusion criteria by consensus of 2 authors. Additionally, we solicited unpublished data from all authors of cohort studies with >100 patients published within the last 10 years, and received data from 15 more studies. Univariate and multivariable-adjusted odds ratios (ORs) for mortality and poor functional outcome were abstracted as available and pooled using a random effects model.


RESULTS
We obtained mortality data from 25 cohorts (15 unpublished) and functional outcome data from 21 cohorts (14 unpublished). Pre-ICH APT users had increased mortality in both univariate (OR 1.41, 95% confidence interval [CI] 1.21 to 1.64) and multivariable-adjusted (OR 1.27, 95% CI 1.10 to 1.47) pooled analyses. By contrast, the pooled OR for poor functional outcome was no longer significant when using multivariable-adjusted estimates (univariate OR 1.29, 95% CI 1.09 to 1.53; multivariable-adjusted OR 1.10, 95% CI 0.93 to 1.29).


CONCLUSIONS
In cohort studies, APT use at the time of ICH compared to no APT use was independently associated with increased mortality but not with poor functional outcome.
Thompson
B B
BB
Department of Neurology, Brown University, Providence, RI, USA.
Béjot
Y
Y
Caso
V
V
Castillo
J
J
Christensen
H
H
Flaherty
M L
ML
Foerch
C
C
Ghandehari
K
K
Giroud
M
M
Greenberg
S M
SM
Hallevi
H
H
Hemphill
J C
JC
Heuschmann
P
P
Juvela
S
S
Kimura
K
K
Myint
P K
PK
Nagakane
Y
Y
Naritomi
H
H
Passero
S
S
Rodríguez-Yáñez
M R
MR
Roquer
J
J
Rosand
J
J
Rost
N S
NS
Saloheimo
P
P
Salomaa
V
V
Sivenius
J
J
Sorimachi
T
T
Togha
M
M
Toyoda
K
K
Turaj
W
W
Vemmos
K N
KN
Wolfe
C D A
CD
Woo
D
D
Smith
E E
EE
D000704:Analysis of Variance; D002543:Cerebral Hemorrhage / Q000188:drug therapy* / Q000401:mortality; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual / Q000706:statistics & numerical data; D006801:Humans; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors
Am J Hypertens. 2006 Apr;19(4):403-6
16580577
Stroke. 2006 Aug;37(8):2165-7
16809556
Stroke. 2007 Mar;38(3):863; author reply 864
17234981
Stroke. 2006 Jan;37(1):129-33
16322483
J Neurosurg. 2007 Feb;106(2):250-4
17410708
Stroke. 2009 Oct;40(10):3396-9
19661471
Arch Intern Med. 2004 Apr 26;164(8):880-4
15111374
JAMA. 2000 Apr 19;283(15):2008-12
10789670
J Neurol. 2002 Dec;249(12):1704-9
12529793
Lancet. 2004 Jul 24-30;364(9431):331-7
15276392
Stroke. 2004 Feb;35(2):420-5
14707234
Stroke. 2001 Apr;32(4):891-7
11283388
Stroke. 1999 Aug;30(8):1538-41
10436097
J Neurol. 2005 Apr;252(4):412-6
15739042
Neuroepidemiology. 2007;28(2):79-85
17230027
Neurology. 2003 Nov 25;61(10):1351-6
14638954
Ann Intern Med. 2006 Mar 21;144(6):427-37
16549855
Stroke. 1999 Nov;30(11):2326-30
10548666
J Neurol Sci. 2005 Jul 15;234(1-2):99-103
15935384
Neurology. 2006 Apr 25;66(8):1182-6
16636234
Neurology. 2004 Aug 10;63(3):461-7
15304576
Cerebrovasc Dis. 2000 Mar-Apr;10(2):133-41
10686452
Lancet. 2006 Jun 10;367(9526):1903-12
16765759
Neurology. 2005 Oct 11;65(7):1000-4
16217049
Stroke. 2006 Feb;37(2):487-91
16373642
Cerebrovasc Dis. 2007;23(2-3):132-9
17124394
Cerebrovasc Dis. 2007;24(5):439-44
17878725
BMC Neurol. 2004 Jun 14;4:9
15193159
J Neurol Neurosurg Psychiatry. 2002 Feb;72(2):211-6
11796771
Stroke. 2008 Aug;39(8):2304-9
18556582
J Neurol Sci. 2007 Apr 15;255(1-2):90-4
17350046
J Neurosurg. 2002 Sep;97(3):531-6
12296635
Cerebrovasc Dis. 2007;24(2-3):215-8
17630480
Med Sci Monit. 2002 Oct;8(10):CR702-7
12388923
Acad Emerg Med. 2007 Aug;14(8):695-701
17656606