▪, University Hospital Southampton, Southampton, UK.
▪, University of Oxford, Oxford, UK.
Int J Stroke. 2022 Mar;17(3):341-353. doi: 10.1177/17474930211004888. Epub 2021 Apr 4.
Some studies have shown a protective association between aspirin use and subarachnoid hemorrhage. Other studies have found no relationship or the reverse. These studies differ in their study populations and definitions of subarachnoid hemorrhage.
Our aim was to establish (1) if there is an association between aspirin and subarachnoid hemorrhage, (2) how this differs between the general population and those with intracranial aneurysms.
Studies reporting aspirin use and the occurrence of subarachnoid hemorrhage were included and grouped based on population (general population vs. aneurysm population). Odds ratios, hazard ratios, and confidence intervals were combined in random-effects models. Eleven studies were included. Overall, there was an association between aspirin and subarachnoid hemorrhage (OR 0.68 [0.48, 0.96]). However, populations were diverse and heterogeneity between studies high ( < 0.00001), questioning the validity of combining these studies and justifying analysis by population. In the general population, there was no difference in aspirin use between individuals with and without subarachnoid hemorrhage (OR 1.15 [0.96, 1.38]). In patients with intracranial aneurysms, aspirin use was greater in patients without subarachnoid hemorrhage (OR 0.37 [0.24, 0.58]), although these studies were at higher risk of bias.
There is an association between aspirin use and subarachnoid hemorrhage in patients with intracranial aneurysms. This apparent protective relationship is not seen in the general population. Prospective randomized studies are required to further investigate the effect of aspirin on unruptured intracranial aneurysms.
一些研究表明，阿司匹林的使用与蛛网膜下腔出血之间存在保护关联。其他研究则没有发现这种关系或发现了相反的结果。这些研究在研究人群和蛛网膜下腔出血的定义上存在差异。
我们的目的是确定（1）阿司匹林与蛛网膜下腔出血之间是否存在关联，（2）这种关联在普通人群和颅内动脉瘤患者中是否存在差异。
纳入了报告阿司匹林使用与蛛网膜下腔出血发生情况的研究，并根据人群（普通人群与动脉瘤人群）进行分组。使用随机效应模型对比值比、风险比和置信区间进行合并。共纳入了 11 项研究。总体而言，阿司匹林与蛛网膜下腔出血之间存在关联（OR 0.68 [0.48, 0.96]）。然而，人群差异较大且研究间异质性高（ < 0.00001），这使得合并这些研究的有效性受到质疑，并需要按人群进行分析。在普通人群中，蛛网膜下腔出血患者与无蛛网膜下腔出血患者之间的阿司匹林使用情况无差异（OR 1.15 [0.96, 1.38]）。在颅内动脉瘤患者中，无蛛网膜下腔出血的患者中阿司匹林的使用更为普遍（OR 0.37 [0.24, 0.58]），尽管这些研究存在更高的偏倚风险。
颅内动脉瘤患者中，阿司匹林的使用与蛛网膜下腔出血之间存在关联。这种看似保护的关系在普通人群中并未出现。需要进行前瞻性随机研究，以进一步探讨阿司匹林对未破裂颅内动脉瘤的影响。
