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Meta-Analysis
. 2007 Oct 17;2007(4):CD006184.
doi: 10.1002/14651858.CD006184.pub2.

Antiplatelet therapy for aneurysmal subarachnoid haemorrhage

S M Dorhout Mees, W M van den Bergh, A Algra, G J E Rinkel
Meta-Analysis

Antiplatelet therapy for aneurysmal subarachnoid haemorrhage

S M Dorhout Mees et al. Cochrane Database Syst Rev. .

Abstract

Background: Secondary ischaemia is a frequent cause of poor outcome in patients with aneurysmal subarachnoid haemorrhage (SAH). Besides vasospasm, platelet aggregation seems to play a role in the pathogenesis of secondary ischaemia. Experimental studies have suggested that antiplatelet agents can prevent secondary ischaemia.

Objectives: To determine whether antiplatelet agents change outcome in patients with aneurysmal SAH.

Search strategy: We searched the Cochrane Stroke Group Trials Register (last searched August 2006), MEDLINE (1966 to August 2006) and EMBASE databases (1980 to August 2006). We also searched reference lists of identified trials.

Selection criteria: All randomised controlled trials (RCTs) comparing any antiplatelet agent with control in patients with aneurysmal SAH.

Data collection and analysis: Two review authors independently extracted the data and assessed trial quality. Relative risks (RR) were calculated with regard to poor outcome, case fatality, secondary ischaemia, haemorrhagic intracranial complications and aneurysmal rebleeding according to the intention-to-treat principle. In case of a statistically significant primary analysis, a worst case analysis was performed.

Main results: Seven RCTs were included in the review, totalling 1385 patients. Four of these trials met the criteria for good quality studies. For any antiplatelet agent there were reductions of a poor outcome (RR 0.79, 95% confidence interval (CI) 0.62 to 1.01) and secondary brain ischaemia (RR 0.79, 95% CI 0.56 to 1.22) and more intracranial haemorrhagic complications (RR 1.36, 95% CI 0.59 to 3.12), but none of these differences were statistically significant. There was no effect on case fatality (RR 1.01, 95% CI 0.74 to 1.37) or aneurysmal rebleeding (RR 0.98, 95% CI 0.78 to 1.38). For individual antiplatelet agents, only ticlopidine was associated with statistically significant fewer occurrences of a poor outcome (RR 0.37, 95% CI 95% CI 0.14 to 0.98) but this estimate was based on only one small RCT.

Authors' conclusions: This review shows a trend towards better outcome in patients treated with antiplatelet agents, possibly due to a reduction in secondary ischaemia. However, results were not statistically significant, thus no definite conclusions can be drawn. Also, antiplatelet agents could increase the risk of haemorrhagic complications. On the basis of the current evidence treatment with antiplatelet agents in order to prevent secondary ischaemia or poor outcome cannot be recommended.

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Conflict of interest statement

The authors were involved in the organisation and writing of two of the included RCTs (Hop 2000; van den Bergh 2006).

Figures

1.1
1.1. Analysis
Comparison 1 Poor outcome, Outcome 1 Poor outcome, according to type of medication.
1.2
1.2. Analysis
Comparison 1 Poor outcome, Outcome 2 Poor outcome, according to start of study medication.
2.1
2.1. Analysis
Comparison 2 Case fatality, Outcome 1 Case fatality, according to type of medication.
2.2
2.2. Analysis
Comparison 2 Case fatality, Outcome 2 Case fatality, according to start of study medication.
3.1
3.1. Analysis
Comparison 3 Secondary ischaemia, Outcome 1 Clinical signs of secondary ischaemia.
3.2
3.2. Analysis
Comparison 3 Secondary ischaemia, Outcome 2 Infarction on CT.
4.1
4.1. Analysis
Comparison 4 Intracranial haemorrhagic complications, Outcome 1 Intracranial hemorrhagic complications according to type of medication.
4.2
4.2. Analysis
Comparison 4 Intracranial haemorrhagic complications, Outcome 2 Intracranial haemorrhagic complications according to start of study medication.
5.1
5.1. Analysis
Comparison 5 Rebleeding, Outcome 1 Rebleeding according to type of medication.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD006184

References

References to studies included in this review

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