Benefits and risks of resumption of antiplatelet therapy in patients after intracranial hemorrhage: a Meta-analysis

Abstract

Objective To assess the benefits and risks of resumption of antiplatelet therapy in patients after intracranial hemorrhage (ICH) by Meta-analysis. Methods Retrieve relevant case-control studies or cohort studies from online databases (January 1, 1990-June 1, 2018) as PubMed, EMBASE/SCOPUS and Cochrane Online Library with key words: intracranial hemorrhages, intracerebral hemorrhages, brain hemorrhages, antiplatelet, restart, resumption. Selection of studies was performed according to pre-designed inclusion and exclusion criteria. Quality of studies was evaluated by using Newcastle-Ottawa Scale (NOS). All data were pooled by RevMan 5.2 software for Meta-analysis. Results The research enrolled 4403 articles, from which 12 high-quality (NOS ≥ 6 scores) studies were chosen after excluding duplicates and those not meeting the inclusion criteria. A total of 4191 cases (1325 cases with resumption of antiplatelet therapy and 2866 cases without resumption of antiplatelet therapy) were included. Meta-analysis showed that comparing with non-resumption of antiplatelet therapy, resumption of antiplatelet therapy was effective in reducing the incidence of ischemic vascular events (RR = 0.700, 95% CI: 0.570-0.850; P = 0.001). There were no significant differences in the risk of ICH recurrence or hematoma expansion (RR = 0.830, 95%CI: 0.580-1.170; P = 0.290) and the incidence of vascular death (RR = 1.300, 95% CI: 0.920-1.840; P = 0.140) between patients with and without resumption of antiplatelet therapy. Conclusions Resumption of antiplatelet therapy in patients after primary ICH effectively reduced the risk of ischemic vascular events, without significant increase of risk of ICH recurrence or hematoma expansion and the occurrence of vascular death.

DOI: 10.3969/j.issn.1672-6731.2018.11.005