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Review
. 2010 Oct 12;75(15):1333-42.
doi: 10.1212/WNL.0b013e3181f735e5. Epub 2010 Sep 8.

Prior antiplatelet therapy and outcome following intracerebral hemorrhage: a systematic review

B B Thompson  1 , Y Béjot, V Caso, J Castillo, H Christensen, M L Flaherty, C Foerch, K Ghandehari, M Giroud, S M Greenberg, H Hallevi, J C Hemphill 3rd, P Heuschmann, S Juvela, K Kimura, P K Myint, Y Nagakane, H Naritomi, S Passero, M R Rodríguez-Yáñez, J Roquer, J Rosand, N S Rost, P Saloheimo, V Salomaa, J Sivenius, T Sorimachi, M Togha, K Toyoda, W Turaj, K N Vemmos, C D A Wolfe, D Woo, E E Smith
Affiliations
Review

Prior antiplatelet therapy and outcome following intracerebral hemorrhage: a systematic review

B B Thompson et al. Neurology. .

Abstract

Objectives: 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 Additionally, we solicited unpublished data from all authors of cohort studies with 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Results: We obtained mortality data from 25 cohorts (15 unpublished) and functional outcome data from 21 cohorts (14 unpublished).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.

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Figures

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Figure 1 Funnel plots Funnel plots of univariate odds ratios for mortality (A) and poor functional outcome (B).
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Figure 2 Odds ratios for mortality Unadjusted (A) and multivariable-adjusted (B) ORs for mortality in pre-ICH antiplatelet therapy (APT) users compared to nonusers. CI = confidence interval; ICH = intracerebral hemorrhage; OR = odds ratio.
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Figure 3 Odds ratios for poor functional outcome Unadjusted (A) and multivariable-adjusted (B) ORs for poor functional outcome in pre-ICH antiplatelet therapy (APT) users compared to nonusers. CI = confidence interval; ICH = intracerebral hemorrhage; OR = odds ratio.
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Figure 4 Outcomes in specific subgroups Adjusted odds ratios for mortality (A) and poor functional outcome (B), in pre-ICH antiplatelet user compared to nonusers, according to prespecified study subgroups. APT = antiplatelet therapy; BI = Barthel Index; GOS = Glasgow Outcome Scale; ICH = intracerebral hemorrhage; mRS = modified Rankin Scale; Ref = reference category.
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