Background

Delayed cerebral ischemia (DCI) strongly impacts clinical outcomes after aneurysmal SAH. The effect of the antiplatelet therapy (AT) on DCI has been described with heterogeneous results.

Purpose

To analyze the efficacy of AT on DCI and clinical outcomes in patients with SAH.

Data Sources

A systematic search of three databases was performed for studies published from 1990 to 2019.

Study Selection

According to PRISMA guidelines, we included studies comparing the rates of DCI and clinical outcomes among SAH patients with and without AT.

Data Analysis

Random-effects meta-analysis was used to pool the following: DCI, mortality and good outcome rates.

Data Synthesis

Including 7 studies, 1060 and 1762 SAH patients were surgically and endovascularly treated with (cases) and without (controls) AT, respectively. Overall, AT did not significantly decrease DCI rate compared to the control group (219/1060 vs. 485/1762,OR = 0.781, 95%CI = 0.46-1.31, P= .33). Among patients treated endovascularly, there was a trend toward lower DCI rates after AT (157/778 vs. 413/1410,OR = 0.552, 95%CI = 0.273-1.115, P = .06). Long-term (> 2 weeks) AT tended to be associated with a lower incidence of DCI (63/438 vs. 96/353,OR = 0.379, 95%CI = 0.12-1.2, P= .06). Good outcome rate was significantly higher (803/1144 vs. 1175/1775,OR = 1.368, 95%CI = 1.117-1.676, P= .002), and mortality rate was significantly lower among the AT group (79/672 vs. 97/571,OR = 0.656, 95%CI = 0.47-0.91, P= .01).

Limitations

Heterogeneity was high for most of the outcomes.

Conclusions

Overall, the incidence of DCI seems to not be significantly reduced among the AT group. However, DCI tends to be lower both among subjects with long-term AT and among patients with endovascular treatments and antiplatelet administration. Poor outcome and mortality rates are significantly reduced among the AT group.

中文翻译：

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动脉瘤性蛛网膜下腔出血患者的抗血小板治疗：对延迟性脑缺血和临床结局的影响。荟萃分析

背景

延迟性脑缺血（DCI）严重影响动脉瘤SAH后的临床结局。抗血小板治疗（AT）对DCI的作用已被异质性描述。

目的

分析AT对SAH患者DCI的疗效和临床结局。

数据源

对1990年至2019年发表的研究进行了三个数据库的系统搜索。

研究选择

根据PRISMA指南，我们纳入了比较有无AT的SAH患者DCI率和临床结局的研究。

数据分析

随机效应荟萃分析用于汇总以下内容：DCI，死亡率和良好的预后率。

数据综合

包括7项研究，分别对1060例SAH患者和1762例SAH患者进行了（病例）和不使用（对照）AT的手术和血管内治疗。总体而言，与对照组相比，AT并未显着降低DCI率（219/1060对485/1762，OR = 0.781，95％CI = 0.46-1.31，P = 0.33 ）。在接受血管内治疗的患者中，AT后有降低DCI的趋势（157/778对413/1410，OR = 0.552，95％CI = 0.273-1.115，P  = .06）。长期（> 2周）AT往往与DCI发生率较低相关（63/438对96/353，OR = 0.379，95％CI = 0.12-1.2，P = .06）。良好的结局率明显更高（803/1144比1175/1775，OR = 1.368，95％CI = 1.117-1.676，P= 0.002），而AT组的死亡率则明显较低（79/672对97/571，OR = 0.656，95％CI = 0.47-0.91，P = 0.01）。

局限性

大多数结果的异质性很高。

结论

总体而言，AT组中DCI的发生率似乎并未显着降低。然而，在长期接受AT治疗的患者以及接受血管内治疗和抗血小板治疗的患者中，DCI都趋于降低。AT组的不良结局和死亡率显着降低。