Prior antiplatelet therapy and outcome following intracerebral hemorrhage: a systematic review

B B Thompson, Y Béjot, V Caso, J Castillo, H Christensen, M L Flaherty, C Foerch, K Ghandehari, M Giroud, S M Greenberg, H Hallevi, J C Hemphill, P Heuschmann, S Juvela, K Kimura, P K Myint, Y Nagakane, H Naritomi, S Passero, M R Rodríguez-Yáñez & 14 others J Roquer, J Rosand, N S Rost, P Saloheimo, V Salomaa, J Sivenius, T Sorimachi, M Togha, K Toyoda, W Turaj, K N Vemmos, C D A Wolfe, D Woo, E E Smith

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: Antiplatelet therapy (APT) promotes bleeding; therefore, APT might worsen outcome in patients with intracerebral hemorrhage (ICH). We performed a systematic review and meta-analysis to address the hypothesis that pre-ICH APT use is associated with mortality and poor functional outcome following ICH.

METHODS: The Medline and Embase databases were searched in February 2008 using relevant key words, limited to human studies in the English language. Cohort studies of consecutive patients with ICH reporting mortality or functional outcome according to pre-ICH APT use were identified. Of 2,873 studies screened, 10 were judged to meet inclusion criteria by consensus of 2 authors. Additionally, we solicited unpublished data from all authors of cohort studies with >100 patients published within the last 10 years, and received data from 15 more studies. Univariate and multivariable-adjusted odds ratios (ORs) for mortality and poor functional outcome were abstracted as available and pooled using a random effects model.

RESULTS: We obtained mortality data from 25 cohorts (15 unpublished) and functional outcome data from 21 cohorts (14 unpublished). Pre-ICH APT users had increased mortality in both univariate (OR 1.41, 95% confidence interval [CI] 1.21 to 1.64) and multivariable-adjusted (OR 1.27, 95% CI 1.10 to 1.47) pooled analyses. By contrast, the pooled OR for poor functional outcome was no longer significant when using multivariable-adjusted estimates (univariate OR 1.29, 95% CI 1.09 to 1.53; multivariable-adjusted OR 1.10, 95% CI 0.93 to 1.29).

CONCLUSIONS: In cohort studies, APT use at the time of ICH compared to no APT use was independently associated with increased mortality but not with poor functional outcome.

Original languageEnglish
Pages (from-to)1333-1342
Number of pages10
JournalNeurology
Volume75
Issue number15
DOIs
Publication statusPublished - 12 Oct 2010

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Cerebral Hemorrhage
Odds Ratio
Mortality
Confidence Intervals
Cohort Studies
Therapeutics
Meta-Analysis
Consensus
Language
Databases
Hemorrhage

Keywords

  • analysis of variance
  • cerebral hemorrhage
  • cohort studies
  • confidence intervals
  • databases, factual
  • humans
  • odds ratio
  • platelet aggregation inhibitors
  • treatment outcome

Cite this

Thompson, B. B., Béjot, Y., Caso, V., Castillo, J., Christensen, H., Flaherty, M. L., ... Smith, E. E. (2010). Prior antiplatelet therapy and outcome following intracerebral hemorrhage: a systematic review. Neurology, 75(15), 1333-1342. https://doi.org/10.1212/WNL.0b013e3181f735e5

Prior antiplatelet therapy and outcome following intracerebral hemorrhage : a systematic review. / Thompson, B B; Béjot, Y; Caso, V; Castillo, J; Christensen, H; Flaherty, M L; Foerch, C; Ghandehari, K; Giroud, M; Greenberg, S M; Hallevi, H; Hemphill, J C; Heuschmann, P; Juvela, S; Kimura, K; Myint, P K; Nagakane, Y; Naritomi, H; Passero, S; Rodríguez-Yáñez, M R; Roquer, J; Rosand, J; Rost, N S; Saloheimo, P; Salomaa, V; Sivenius, J; Sorimachi, T; Togha, M; Toyoda, K; Turaj, W; Vemmos, K N; Wolfe, C D A; Woo, D; Smith, E E.

In: Neurology, Vol. 75, No. 15, 12.10.2010, p. 1333-1342.

Research output: Contribution to journalArticle

Thompson, BB, Béjot, Y, Caso, V, Castillo, J, Christensen, H, Flaherty, ML, Foerch, C, Ghandehari, K, Giroud, M, Greenberg, SM, Hallevi, H, Hemphill, JC, Heuschmann, P, Juvela, S, Kimura, K, Myint, PK, Nagakane, Y, Naritomi, H, Passero, S, Rodríguez-Yáñez, MR, Roquer, J, Rosand, J, Rost, NS, Saloheimo, P, Salomaa, V, Sivenius, J, Sorimachi, T, Togha, M, Toyoda, K, Turaj, W, Vemmos, KN, Wolfe, CDA, Woo, D & Smith, EE 2010, 'Prior antiplatelet therapy and outcome following intracerebral hemorrhage: a systematic review' Neurology, vol. 75, no. 15, pp. 1333-1342. https://doi.org/10.1212/WNL.0b013e3181f735e5
Thompson BB, Béjot Y, Caso V, Castillo J, Christensen H, Flaherty ML et al. Prior antiplatelet therapy and outcome following intracerebral hemorrhage: a systematic review. Neurology. 2010 Oct 12;75(15):1333-1342. https://doi.org/10.1212/WNL.0b013e3181f735e5
Thompson, B B ; Béjot, Y ; Caso, V ; Castillo, J ; Christensen, H ; Flaherty, M L ; Foerch, C ; Ghandehari, K ; Giroud, M ; Greenberg, S M ; Hallevi, H ; Hemphill, J C ; Heuschmann, P ; Juvela, S ; Kimura, K ; Myint, P K ; Nagakane, Y ; Naritomi, H ; Passero, S ; Rodríguez-Yáñez, M R ; Roquer, J ; Rosand, J ; Rost, N S ; Saloheimo, P ; Salomaa, V ; Sivenius, J ; Sorimachi, T ; Togha, M ; Toyoda, K ; Turaj, W ; Vemmos, K N ; Wolfe, C D A ; Woo, D ; Smith, E E. / Prior antiplatelet therapy and outcome following intracerebral hemorrhage : a systematic review. In: Neurology. 2010 ; Vol. 75, No. 15. pp. 1333-1342.
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abstract = "OBJECTIVES: Antiplatelet therapy (APT) promotes bleeding; therefore, APT might worsen outcome in patients with intracerebral hemorrhage (ICH). We performed a systematic review and meta-analysis to address the hypothesis that pre-ICH APT use is associated with mortality and poor functional outcome following ICH.METHODS: The Medline and Embase databases were searched in February 2008 using relevant key words, limited to human studies in the English language. Cohort studies of consecutive patients with ICH reporting mortality or functional outcome according to pre-ICH APT use were identified. Of 2,873 studies screened, 10 were judged to meet inclusion criteria by consensus of 2 authors. Additionally, we solicited unpublished data from all authors of cohort studies with >100 patients published within the last 10 years, and received data from 15 more studies. Univariate and multivariable-adjusted odds ratios (ORs) for mortality and poor functional outcome were abstracted as available and pooled using a random effects model.RESULTS: We obtained mortality data from 25 cohorts (15 unpublished) and functional outcome data from 21 cohorts (14 unpublished). Pre-ICH APT users had increased mortality in both univariate (OR 1.41, 95{\%} confidence interval [CI] 1.21 to 1.64) and multivariable-adjusted (OR 1.27, 95{\%} CI 1.10 to 1.47) pooled analyses. By contrast, the pooled OR for poor functional outcome was no longer significant when using multivariable-adjusted estimates (univariate OR 1.29, 95{\%} CI 1.09 to 1.53; multivariable-adjusted OR 1.10, 95{\%} CI 0.93 to 1.29).CONCLUSIONS: In cohort studies, APT use at the time of ICH compared to no APT use was independently associated with increased mortality but not with poor functional outcome.",
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T1 - Prior antiplatelet therapy and outcome following intracerebral hemorrhage

T2 - a systematic review

AU - Thompson, B B

AU - Béjot, Y

AU - Caso, V

AU - Castillo, J

AU - Christensen, H

AU - Flaherty, M L

AU - Foerch, C

AU - Ghandehari, K

AU - Giroud, M

AU - Greenberg, S M

AU - Hallevi, H

AU - Hemphill, J C

AU - Heuschmann, P

AU - Juvela, S

AU - Kimura, K

AU - Myint, P K

AU - Nagakane, Y

AU - Naritomi, H

AU - Passero, S

AU - Rodríguez-Yáñez, M R

AU - Roquer, J

AU - Rosand, J

AU - Rost, N S

AU - Saloheimo, P

AU - Salomaa, V

AU - Sivenius, J

AU - Sorimachi, T

AU - Togha, M

AU - Toyoda, K

AU - Turaj, W

AU - Vemmos, K N

AU - Wolfe, C D A

AU - Woo, D

AU - Smith, E E

PY - 2010/10/12

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N2 - OBJECTIVES: Antiplatelet therapy (APT) promotes bleeding; therefore, APT might worsen outcome in patients with intracerebral hemorrhage (ICH). We performed a systematic review and meta-analysis to address the hypothesis that pre-ICH APT use is associated with mortality and poor functional outcome following ICH.METHODS: The Medline and Embase databases were searched in February 2008 using relevant key words, limited to human studies in the English language. Cohort studies of consecutive patients with ICH reporting mortality or functional outcome according to pre-ICH APT use were identified. Of 2,873 studies screened, 10 were judged to meet inclusion criteria by consensus of 2 authors. Additionally, we solicited unpublished data from all authors of cohort studies with >100 patients published within the last 10 years, and received data from 15 more studies. Univariate and multivariable-adjusted odds ratios (ORs) for mortality and poor functional outcome were abstracted as available and pooled using a random effects model.RESULTS: We obtained mortality data from 25 cohorts (15 unpublished) and functional outcome data from 21 cohorts (14 unpublished). Pre-ICH APT users had increased mortality in both univariate (OR 1.41, 95% confidence interval [CI] 1.21 to 1.64) and multivariable-adjusted (OR 1.27, 95% CI 1.10 to 1.47) pooled analyses. By contrast, the pooled OR for poor functional outcome was no longer significant when using multivariable-adjusted estimates (univariate OR 1.29, 95% CI 1.09 to 1.53; multivariable-adjusted OR 1.10, 95% CI 0.93 to 1.29).CONCLUSIONS: In cohort studies, APT use at the time of ICH compared to no APT use was independently associated with increased mortality but not with poor functional outcome.

AB - OBJECTIVES: Antiplatelet therapy (APT) promotes bleeding; therefore, APT might worsen outcome in patients with intracerebral hemorrhage (ICH). We performed a systematic review and meta-analysis to address the hypothesis that pre-ICH APT use is associated with mortality and poor functional outcome following ICH.METHODS: The Medline and Embase databases were searched in February 2008 using relevant key words, limited to human studies in the English language. Cohort studies of consecutive patients with ICH reporting mortality or functional outcome according to pre-ICH APT use were identified. Of 2,873 studies screened, 10 were judged to meet inclusion criteria by consensus of 2 authors. Additionally, we solicited unpublished data from all authors of cohort studies with >100 patients published within the last 10 years, and received data from 15 more studies. Univariate and multivariable-adjusted odds ratios (ORs) for mortality and poor functional outcome were abstracted as available and pooled using a random effects model.RESULTS: We obtained mortality data from 25 cohorts (15 unpublished) and functional outcome data from 21 cohorts (14 unpublished). Pre-ICH APT users had increased mortality in both univariate (OR 1.41, 95% confidence interval [CI] 1.21 to 1.64) and multivariable-adjusted (OR 1.27, 95% CI 1.10 to 1.47) pooled analyses. By contrast, the pooled OR for poor functional outcome was no longer significant when using multivariable-adjusted estimates (univariate OR 1.29, 95% CI 1.09 to 1.53; multivariable-adjusted OR 1.10, 95% CI 0.93 to 1.29).CONCLUSIONS: In cohort studies, APT use at the time of ICH compared to no APT use was independently associated with increased mortality but not with poor functional outcome.

KW - analysis of variance

KW - cerebral hemorrhage

KW - cohort studies

KW - confidence intervals

KW - databases, factual

KW - humans

KW - odds ratio

KW - platelet aggregation inhibitors

KW - treatment outcome

U2 - 10.1212/WNL.0b013e3181f735e5

DO - 10.1212/WNL.0b013e3181f735e5

M3 - Article

VL - 75

SP - 1333

EP - 1342

JO - Neurology

JF - Neurology

SN - 0028-3878

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