title: Prior antiplatelet therapy and outcome following intracerebral hemorrhage: a systematic review.
abstract: 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 Additionally, we solicited unpublished data from all authors of cohort studies with 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  We obtained mortality data from 25 cohorts (15 unpublished) and functional outcome data from 21 cohorts (14 unpublished).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.
authors.affiliation: Department of Neurology, Brown University, Providence, RI, USA.
authors.forename: B B
authors.initials: BB
authors.lastname: Thompson
authors.forename: Y
authors.initials: Y
authors.lastname: Béjot
authors.forename: V
authors.initials: V
authors.lastname: Caso
authors.forename: J
authors.initials: J
authors.lastname: Castillo
authors.forename: H
authors.initials: H
authors.lastname: Christensen
authors.forename: M L
authors.initials: ML
authors.lastname: Flaherty
authors.forename: C
authors.initials: C
authors.lastname: Foerch
authors.forename: K
authors.initials: K
authors.lastname: Ghandehari
authors.forename: M
authors.initials: M
authors.lastname: Giroud
authors.forename: S M
authors.initials: SM
authors.lastname: Greenberg
authors.forename: H
authors.initials: H
authors.lastname: Hallevi
authors.forename: J C
authors.initials: JC
authors.lastname: Hemphill
authors.forename: P
authors.initials: P
authors.lastname: Heuschmann
authors.forename: S
authors.initials: S
authors.lastname: Juvela
authors.forename: K
authors.initials: K
authors.lastname: Kimura
authors.forename: P K
authors.initials: PK
authors.lastname: Myint
authors.forename: Y
authors.initials: Y
authors.lastname: Nagakane
authors.forename: H
authors.initials: H
authors.lastname: Naritomi
authors.forename: S
authors.initials: S
authors.lastname: Passero
authors.forename: M R
authors.initials: MR
authors.lastname: Rodríguez-Yáñez
authors.forename: J
authors.initials: J
authors.lastname: Roquer
authors.forename: J
authors.initials: J
authors.lastname: Rosand
authors.forename: N S
authors.initials: NS
authors.lastname: Rost
authors.forename: P
authors.initials: P
authors.lastname: Saloheimo
authors.forename: V
authors.initials: V
authors.lastname: Salomaa
authors.forename: J
authors.initials: J
authors.lastname: Sivenius
authors.forename: T
authors.initials: T
authors.lastname: Sorimachi
authors.forename: M
authors.initials: M
authors.lastname: Togha
authors.forename: K
authors.initials: K
authors.lastname: Toyoda
authors.forename: W
authors.initials: W
authors.lastname: Turaj
authors.forename: K N
authors.initials: KN
authors.lastname: Vemmos
authors.forename: C D A
authors.initials: CD
authors.lastname: Wolfe
authors.forename: D
authors.initials: D
authors.lastname: Woo
authors.forename: E E
authors.initials: EE
authors.lastname: Smith
mesh_terms: 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
chemical_list: D010975:Platelet Aggregation Inhibitors
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