Journal
NEUROLOGY
Volume 75, Issue 15, Pages 1333-1342Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1212/WNL.0b013e3181f735e5
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Funding
- Boehringer Ingelheim
- Augustinusfonden
- NIH [NINDS 2P50NS044283, NINDS R01 NS030678, NINDS R01 NS036695, NINDS R01 NS42167, NINDS R01 NS044876, NINDS R01 NS052220, R01AG026484, K24NS056207, R01AG021084, R01NS042147, U54NS057405, R01-NS059727, NINDS 1K23NS064052-01A1, NS36695, NS30678, 5R01NS062028, K23NS046327]
- Alzheimer's Association
- NIH/NINDS [U10 NS058931]
- Novo Nordisk
- University of California
- European Union
- German Stroke Foundation
- Stanley Thomas Johnson Foundation
- American Heart Association
- National Stroke Association
- American Stroke Association-Bugher Foundation
- Jassen
- Oulu University Hospital
- Academy of Finland
- Finnish Foundation for Cardiovascular Research
- Sigrid Juselius Foundation
- Ministry of Health, Labour and Welfare
- CIHR
- Alberta Heritage Fund for Medical Research
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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 Additionally, we solicited unpublished data from all authors of cohort studies with 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 Results: We obtained mortality data from 25 cohorts (15 unpublished) and functional outcome data from 21 cohorts (14 unpublished).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. Neurology (R) 2010;75:1333-1342
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