Department of Neurosurgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
College of Clinical Medicine, North Sichuan Medical College, Nanchong, 637000, China.
Neurosurg Rev. 2022 Dec;45(6):3523-3536. doi: 10.1007/s10143-022-01877-2. Epub 2022 Sep 30.
Antiplatelet treatment (APT) has been reported to be used in some patients with aneurysmal subarachnoid hemorrhage (aSAH) after endovascular treatment, but there is controversy among different studies regarding its clinical effects. This study intends to conduct a meta-analysis to evaluate the impact of APT on aSAH patients after endovascular treatment. The PubMed, EMBASE, and Cochrane Library databases were systematically searched up to January 2022 for eligible English publications. Quality assessment was conducted for the included studies. Publication bias and heterogeneity were assessed by Egger's test and the I statistic, respectively. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by meta-analysis. Robustness was checked by subgroup and sensitivity analyses. In total, 597 and 522 patients with and without APT, respectively, in 5 retrospective studies were retained for the meta-analysis. Pooled analyses showed that the APT group had a lower mortality (41/499 [8%] versus 56/402 [14%]; OR = 0.533; 95% CI, 0.347-0.820; P = 0.004) and a higher proportion of favorable clinical outcomes (400/532 [75%] versus 266/421 [63%]; OR = 1.801; 95% CI, 1.359-2.414; P = 0.000) than the control group. There was no significant difference in the incidence of hemorrhagic complications (39/564 [7%] versus 26/503 [5%]; OR = 1.386; 95% CI, 0.825-2.329; P = 0.218) between groups. Although the incidence of delayed cerebral ischemia (DCI) was significantly lower in the APT group (65/512 [13%] versus 105/447 [23%]; OR = 0.325; 95% CI, 0.107-0.988; P = 0.048), it showed substantial heterogeneity (I = 64.7%). Subsequent sensitivity analysis suggested that the meta-analysis was robust. Subgroup analyses revealed that long-term (> 2 weeks) APT (60/479 [13%] versus 103/428 [24%]; OR = 0.212; 95% CI, 0.056-0.806; P = 0.023) significantly reduced the DCI rate and that different grouping methods in the included studies may be a source of heterogeneity. In the absence of randomized controlled trials, a meta-analysis of retrospective studies suggested that APT was associated with reduced mortality and better functional outcomes in aSAH patients after endovascular treatment without an increased incidence of hemorrhagic complications. Long-term APT was also associated with a decrease in the incidence of DCI. Well-designed randomized controlled trials are warranted and updated meta-analyses are needed to verify our findings.
抗血小板治疗（APT）已被报道用于一些接受血管内治疗后的颅内动脉瘤性蛛网膜下腔出血（aSAH）患者，但不同研究之间对其临床效果存在争议。本研究旨在进行荟萃分析，以评估 APT 对血管内治疗后 aSAH 患者的影响。系统检索了截至 2022 年 1 月的 PubMed、EMBASE 和 Cochrane 图书馆数据库，以获取符合条件的英文出版物。对纳入的研究进行了质量评估。通过 Egger 检验和 I 统计量评估发表偏倚和异质性。通过荟萃分析计算优势比（OR）及其 95%置信区间（CI）。通过亚组和敏感性分析检查稳健性。共有 5 项回顾性研究分别纳入了 597 例和 522 例接受和未接受 APT 的患者，用于荟萃分析。汇总分析显示，APT 组死亡率较低（41/499[8%]比 56/402[14%]；OR=0.533；95%CI，0.347-0.820；P=0.004），临床结局良好的比例较高（400/532[75%]比 266/421[63%]；OR=1.801；95%CI，1.359-2.414；P=0.000）。两组出血并发症发生率无显著差异（39/564[7%]比 26/503[5%]；OR=1.386；95%CI，0.825-2.329；P=0.218）。尽管 APT 组迟发性脑缺血（DCI）发生率显著较低（65/512[13%]比 105/447[23%]；OR=0.325；95%CI，0.107-0.988；P=0.048），但存在显著异质性（I=64.7%）。随后的敏感性分析表明荟萃分析稳健。亚组分析显示，长期（>2 周）APT（60/479[13%]比 103/428[24%]；OR=0.212；95%CI，0.056-0.806；P=0.023）可显著降低 DCI 发生率，纳入研究中不同的分组方法可能是异质性的来源。在缺乏随机对照试验的情况下，对回顾性研究的荟萃分析表明，APT 可降低血管内治疗后 aSAH 患者的死亡率和改善功能结局，而不增加出血并发症的发生率。长期 APT 也与 DCI 发生率的降低有关。需要设计良好的随机对照试验，并进行更新的荟萃分析以验证我们的研究结果。
