Association Between Prior Antiplatelet Therapy and Prognosis in Patients With Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis.

IF 3.2 4区医学 Q2 PHARMACOLOGY & PHARMACY Clinical therapeutics Pub Date : 2024-09-12 DOI:10.1016/j.clinthera.2024.08.010

Hanxu Zhang, Xiaoran Hou, Yidan Gou, Yanyan Chen, Shuo An, Yingsheng Wei, Rongcai Jiang, Ye Tian, Hengjie Yuan

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Abstract

Purpose: Approximately 20% to 30% of intracerebral hemorrhage (ICH) patients were reported to be on antiplatelet therapy (APT), and association between prior APT and prognosis was unclear. We aimed to clarify the impact of APT on the prognosis of ICH through an updated systematic review and meta-analysis, and to further compare the risk of single APT (SAPT) or dual APT (DAPT) prior to ICH as well as the risk associated with various antiplatelet drugs.

Methods: EMBASE, MEDLINE via Ovid SP and Web of Science were searched from inception of each database to November 4, 2023. Included studies reported prognosis in both patients with prior APT and those without.

Findings: A total of 433,103 patients from 43 studies were included in the meta-analysis. Both univariate and multivariate analyses demonstrated a significant association between prior-APT and an increased mortality risk (odd ratio [OR] 1.43, 95% confidence interval [CI] 1.28-1.59; OR 1.20, 95%CI 1.10-1.30, respectively). The risk was higher in short term follow-up (Univariate OR 1.73, 95%CI 1.22-2.46; Multivariate OR 1.94, 95%CI 1.48-2.55). A notably increased risk of hematoma expansion was also observed in patients previously treated with APT (Univariate OR 1.47, 95%CI 1.12-1.94; Multivariate OR 1.88, 95%CI 1.30-2.71), which were mainly attributed to events within 24 hours. The impact of prior-APT on poor functional outcome was inconsistent between univariate and multivariate analyses. Both direct and indirect comparisons showed that SAPT significantly reduced the risk of mortality (OR 0.67, 95%CI 0.64-0.70; OR 0.84, 95%CI 0.71-0.99) and poor functional outcome (OR 0.84, 95%CI 0.72-0.98; OR 0.81, 95%CI 0.72-0.91) compared to DAPT.

Implications: Prior-APT increased the risk of mortality and hematoma expansion in patients with ICH. The increased risk of mortality and hematoma expansion was more obvious in the short term follow-up and within 24 hours, respectively. The effect of APT on poor functional outcome exhibited inconsistency between univariate and multivariate analyses, suggesting that further investigation is warranted to clarify this relationship. In comparison with DAPT, SAPT could decrease the risk of mortality and poor functional outcome. Further studies focusing on antiplatelet drug response, racial differences, and specific APT regimens may help verify the influence.

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脑出血患者既往抗血小板治疗与预后之间的关系：系统回顾与元分析》。

目的：据报道，约 20% 至 30% 的脑内出血 (ICH) 患者接受过抗血小板治疗 (APT)，而既往 APT 与预后之间的关系尚不明确。我们旨在通过最新的系统综述和荟萃分析来阐明 APT 对 ICH 预后的影响，并进一步比较 ICH 前单一 APT（SAPT）或双重 APT（DAPT）的风险以及与各种抗血小板药物相关的风险：方法：检索EMBASE、通过Ovid SP检索的MEDLINE和Web of Science，检索时间从各数据库建立之初至2023年11月4日。纳入的研究报告了既往有 APT 患者又无 APT 患者的预后情况：荟萃分析共纳入了 43 项研究中的 433 103 例患者。单变量和多变量分析表明，既往有 APT 患者与死亡风险增加之间存在显著关联（奇异比 [OR] 1.43，95% 置信区间 [CI] 分别为 1.28-1.59；OR 1.20，95%CI 1.10-1.30）。短期随访的风险更高（单变量 OR 1.73，95%CI 1.22-2.46；多变量 OR 1.94，95%CI 1.48-2.55）。在之前接受过 APT 治疗的患者中也观察到血肿扩大的风险明显增加（单变量 OR 1.47，95%CI 1.12-1.94；多变量 OR 1.88，95%CI 1.30-2.71），这主要归因于 24 小时内发生的事件。在单变量和多变量分析中，既往APT对不良功能预后的影响并不一致。直接和间接比较均显示，与DAPT相比，SAPT可显著降低死亡风险（OR 0.67，95%CI 0.64-0.70；OR 0.84，95%CI 0.71-0.99）和不良功能预后（OR 0.84，95%CI 0.72-0.98；OR 0.81，95%CI 0.72-0.91）：启示：预先APT会增加ICH患者的死亡率和血肿扩大风险。在短期随访和 24 小时内，死亡率和血肿扩大风险的增加分别更为明显。APT 对不良功能预后的影响在单变量分析和多变量分析中表现出不一致性，这表明需要进一步研究以明确这种关系。与 DAPT 相比，SAPT 可降低死亡率和不良功能预后的风险。针对抗血小板药物反应、种族差异和特定 APT 方案的进一步研究可能有助于验证这种影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical therapeutics 医学-药学

CiteScore

6.00

自引率

3.10%

发文量

154

审稿时长

9 weeks

期刊介绍： Clinical Therapeutics provides peer-reviewed, rapid publication of recent developments in drug and other therapies as well as in diagnostics, pharmacoeconomics, health policy, treatment outcomes, and innovations in drug and biologics research. In addition Clinical Therapeutics features updates on specific topics collated by expert Topic Editors. Clinical Therapeutics is read by a large international audience of scientists and clinicians in a variety of research, academic, and clinical practice settings. Articles are indexed by all major biomedical abstracting databases.