PDF(Pubmed)
Abstract：
BACKGROUND: There has long been clinical disagreement over the resumption of antiplatelet therapy in patients with primary intracranial hemorrhage (ICH). This meta-analysis aimed to systematically evaluate the efficacy and safety of restarting antiplatelet therapy after ICH among different races and ethnicities.
METHODS: All relevant medical studies involving adults with antiplatelet-associated ICH published in PubMed, The Cochrane Library and Chinese National Knowledge Infrastructure from inception to March 2024 were sourced. Outcome measures were thromboembolic events (stroke and myocardial infarction) and recurrence of ICH. After assessing study heterogeneity and publication bias, we performed a meta-analysis using random-effects model to assess the strength of association between resumption of antiplatelet therapy and our outcomes.The review was not registered and the review protocol was not prepared.
RESULTS: Thirty-five studies were included, with 9758 ICH patients. Subgroup analysis revealed that restarting antiplatelet therapy was associated with a significantly higher risk of recurrence or aggravation of cerebral hemorrhage in Asians[OR = 1.48, 95% CI (1.13-1.94), P = 0.004]; in Caucasians, on the contrary, reinitiation of antiplatelet therapy was not associated with a significantly higher risk of recurrence or aggravation of cerebral hemorrhage [OR = 0.85, 95% CI (0.67-1.06), P = 0.149]. Reinitiation of antiplatelet therapy was associated with a significantly lower risk of cerebral infarction [OR = 0.61, 95% CI (0.39-0.96), P = 0.033]. Restarting antiplatelet therapy after cerebral hemorrhage was not associated with a higher incidence rate of mortality [OR = 0.79, 95% CI (0.57, 1.08), P = 0.138], myocardial infarction [OR = 2.40, 95%CI (0.53,10.79), P = 0.253], hemiparesis [OR = 0.38, 95%CI (0.03,4.81), P = 0.451], neurological deficit [OR = 0.86,95%CI(0.32,2.33),P = 0.766].
CONCLUSIONS: Reinstitution of antiplatelet therapy after ICH was associated with a lower risk of thromboembolic complications.Resumption of antiplatelet therapy was not associated with a higher incidence of cerebral hemorrhage in Caucasians, but may be associated with a higher risk of cerebral hemorrhage recurrence in Asian populations.
METHODS: All relevant medical studies involving adults with antiplatelet-associated ICH published in PubMed, The Cochrane Library and Chinese National Knowledge Infrastructure from inception to March 2024 were sourced. Outcome measures were thromboembolic events (stroke and myocardial infarction) and recurrence of ICH. After assessing study heterogeneity and publication bias, we performed a meta-analysis using random-effects model to assess the strength of association between resumption of antiplatelet therapy and our outcomes.The review was not registered and the review protocol was not prepared.
RESULTS: Thirty-five studies were included, with 9758 ICH patients. Subgroup analysis revealed that restarting antiplatelet therapy was associated with a significantly higher risk of recurrence or aggravation of cerebral hemorrhage in Asians[OR = 1.48, 95% CI (1.13-1.94), P = 0.004]; in Caucasians, on the contrary, reinitiation of antiplatelet therapy was not associated with a significantly higher risk of recurrence or aggravation of cerebral hemorrhage [OR = 0.85, 95% CI (0.67-1.06), P = 0.149]. Reinitiation of antiplatelet therapy was associated with a significantly lower risk of cerebral infarction [OR = 0.61, 95% CI (0.39-0.96), P = 0.033]. Restarting antiplatelet therapy after cerebral hemorrhage was not associated with a higher incidence rate of mortality [OR = 0.79, 95% CI (0.57, 1.08), P = 0.138], myocardial infarction [OR = 2.40, 95%CI (0.53,10.79), P = 0.253], hemiparesis [OR = 0.38, 95%CI (0.03,4.81), P = 0.451], neurological deficit [OR = 0.86,95%CI(0.32,2.33),P = 0.766].
CONCLUSIONS: Reinstitution of antiplatelet therapy after ICH was associated with a lower risk of thromboembolic complications.Resumption of antiplatelet therapy was not associated with a higher incidence of cerebral hemorrhage in Caucasians, but may be associated with a higher risk of cerebral hemorrhage recurrence in Asian populations.
摘要：
背景：对于原发性颅内出血（ICH）患者恢复抗血小板治疗，临床上一直存在分歧。本荟萃分析旨在系统评估不同种族和种族的ICH后重新启动抗血小板治疗的有效性和安全性。
方法：所有涉及成人抗血小板相关性ICH的相关医学研究发表在PubMed,从成立到2024年3月的Cochrane图书馆和中国国家知识基础设施都是来源。预后指标为血栓栓塞事件（卒中和心肌梗死）和ICH复发。在评估研究异质性和发表偏倚后，我们使用随机效应模型进行了荟萃分析,以评估恢复抗血小板治疗与我们的结局之间的相关性.审查没有登记，审查方案也没有准备。
结果：纳入了35项研究，9758名ICH患者。亚组分析显示，重新开始抗血小板治疗与亚洲人脑出血复发或加重的风险显著升高相关[OR=1.48,95%CI(1.13-1.94),P=0.004]；在高加索人中，相反,重新开始抗血小板治疗与脑出血复发或加重的风险无关[OR=0.85,95%CI(0.67-1.06),P=0.149]。重新开始抗血小板治疗与脑梗死风险显著降低相关[OR=0.61,95%CI(0.39-0.96),P=0.033]。脑出血后重新进行抗血小板治疗与较高的死亡率无关[OR=0.79,95%CI(0.57,1.08),P=0.138],心肌梗死[OR=2.40,95CI（0.53,10.79），P=0.253],偏瘫[OR=0.38，95CI（0.03,4.81），P=0.451]，神经功能缺损[OR=0.86,95CI(0.32,2.33)，P=0.766]。
结论：在ICH后重新进行抗血小板治疗与较低的血栓栓塞并发症风险相关。抗血小板治疗的恢复与高加索人脑出血的发生率无关。但可能与亚洲人群脑出血复发的风险较高有关。
方法：所有涉及成人抗血小板相关性ICH的相关医学研究发表在PubMed,从成立到2024年3月的Cochrane图书馆和中国国家知识基础设施都是来源。预后指标为血栓栓塞事件（卒中和心肌梗死）和ICH复发。在评估研究异质性和发表偏倚后，我们使用随机效应模型进行了荟萃分析,以评估恢复抗血小板治疗与我们的结局之间的相关性.审查没有登记，审查方案也没有准备。
结果：纳入了35项研究，9758名ICH患者。亚组分析显示，重新开始抗血小板治疗与亚洲人脑出血复发或加重的风险显著升高相关[OR=1.48,95%CI(1.13-1.94),P=0.004]；在高加索人中，相反,重新开始抗血小板治疗与脑出血复发或加重的风险无关[OR=0.85,95%CI(0.67-1.06),P=0.149]。重新开始抗血小板治疗与脑梗死风险显著降低相关[OR=0.61,95%CI(0.39-0.96),P=0.033]。脑出血后重新进行抗血小板治疗与较高的死亡率无关[OR=0.79,95%CI(0.57,1.08),P=0.138],心肌梗死[OR=2.40,95CI（0.53,10.79），P=0.253],偏瘫[OR=0.38，95CI（0.03,4.81），P=0.451]，神经功能缺损[OR=0.86,95CI(0.32,2.33)，P=0.766]。
结论：在ICH后重新进行抗血小板治疗与较低的血栓栓塞并发症风险相关。抗血小板治疗的恢复与高加索人脑出血的发生率无关。但可能与亚洲人群脑出血复发的风险较高有关。
