Antiplatelet therapy in patients with aneurysmal subarachnoid hemorrhage: Impact on the delayed cerebral ischemia and clinical outcome. A meta-analysis

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.