Efficacy and safety of restarting antiplatelet therapy for patients with spontaneous intracranial haemorrhage: A systematic review and meta-analysis.

Affiliation

Cheng B(1), Li J(2), Peng L(3), Wang Y(4), Sun L(1), He S(1), Wei J(5), Zhang S(1).
Author information:
(1)Department of Neurology, The Affiliated Hospital of Medical College, North Sichuan Medical College
(University, Nanchong, China.
(2)Department of Urology, People's Hospital of Deyang City, Deyang, China.
(3)Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College
(University, Nanchong, China.
(4)Department of Neurology, Chengdu Second People's Hospital, Chengdu, China.
(5)Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China.

Abstract

WHAT IS KNOWN AND OBJECTIVE: The benefits and risks of restarting antiplatelet therapy (APT) for patients with spontaneous intracranial haemorrhage (ICH) remain controversial. This meta-analysis was performed to explore the efficacy and safety of restarting APT for these patients. METHODS: We followed the recommended PRISMA guidelines for systematic reviews. Studies from PubMed, Embase, Web of Science, CNKI and the Cochrane Library were systematically retrieved from the inception of each database to 31 July 2020. We also manually retrieved studies of reference. RESULTS AND DISCUSSION: In this study, seven cohort studies and one randomized controlled trial (RCT) with subjects were included. APT resumption after spontaneous ICH did not significantly increase the risk of major haemorrhagic events (HR 1.15; 95% CI: 0.70-1.89; p = .59). However, it did not significantly reduce the risk of a composite endpoint concerning occlusive/thromboembolic events (HR 0.98; 95% CI: 0.81-1.19; p = .83) and all-cause mortality (HR 0.93; 95% CI: 0.80-1.08; p = .35). WHAT IS NEW AND CONCLUSION: Restarting APT for patients with spontaneous ICH is generally safe. However, the benefits of reducing the risk of ischaemic vascular events and all-cause mortality were not apparent. More RCTs are required.