Antiplatelet Therapy in Patients with Aneurysmal SAH: Impact on Delayed Cerebral Ischemia and Clinical Outcome. A Meta-Analysis
F. Cagnazzo, I. Derraz, P.-H. Lefevre, G. Gascou, C. Dargazanli, C. Riquelme, P. Perrini, D. di Carlo, A. Bonafe and V. Costalat
American Journal of Neuroradiology June 2019, DOI: https://doi.org/10.3174/ajnr.A6086
ArticleFigures & DataSupplementalInfo & MetricsReferences PDF
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Abstract
BACKGROUND AND PURPOSE: Delayed cerebral ischemia strongly impacts clinical outcome after aneurysmal SAH. The effect of antiplatelet therapy on delayed cerebral ischemia has been described with heterogeneous results. Our aim was to analyze the efficacy of antiplatelet therapy on delayed cerebral ischemia and clinical outcome in patients with SAH.

DATA SOURCES: A systematic search of 3 databases was performed for studies published from 1990 to 2019.

STUDY SELECTION: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies comparing the rates of delayed cerebral ischemia and clinical outcomes among patients with SAH with and without antiplatelet therapy.

DATA ANALYSIS: Random-effects meta-analysis was used to pool the following: delayed cerebral ischemia, mortality, and good outcome rates.

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

LIMITATIONS: Heterogeneity was high for most outcomes.

CONCLUSIONS: Overall, the incidence of delayed cerebral ischemia seems not to be significantly reduced among the antiplatelet therapy group. However, delayed cerebral ischemia tended to be lower among subjects with both long-term antiplatelet therapy and endovascular treatment and antiplatelet administration. Poor outcome and mortality rates were significantly reduced among the antiplatelet therapy group.

ABBREVIATIONS:
ASA
acetylsalicylic acid
AT
antiplatelet therapy
CV
cerebral vasospasm
DCI
delayed cerebral ischemia
Footnotes
Disclosures: Paolo Perrini—UNRELATED: Employment: University of Pisa, Comments: consultant neurosurgeon at University of Pisa. Vincent Costalat—UNRELATED: Consultancy: Balt, MicroVention, Medtronic; Grants/Grants Pending: Medtronic, Stryker*; Payment for Development of Educational Presentations: Balt, Medtronic, Stryker, MicroVention. Pierre-Henri Lefevre—UNRELATED: Payment for Development of Educational Presentations: Medtronic. Alain Bonafe—UNRELATED: Consultancy: Medtronic, Stryker, MicroVention.* *Money paid to the institution.

© 2019 by American Journal of Neuroradiology