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Does prior antiplatelet therapy worsen outcomes in patients who suffer intracerebral hemorrhage? To address this question, researchers performed a meta-analysis of 25 cohort studies comprising 9900 patients with intracerebral hemorrhage; 23% of patients had been taking antiplatelet drugs (usually aspirin) at the time of the hemorrhage.
In a multivariable-adjusted pooled analysis, prior antiplatelet therapy was associated with significantly higher mortality (odds ratio, 1.27; P=0.001) but not worse functional outcomes (OR, 1.10).
Thompson BB et al. Prior antiplatelet therapy and outcome following intracerebral hemorrhage: A systematic review. Neurology 2010 Oct 12; 75:1333. (http://dx.doi.org/10.1212/WNL.0b013e3181f735e5)
Comment
In this meta-analysis, patients with intracerebral hemorrhage who were taking antiplatelet drugs had modestly but significantly higher mortality. A limitation of the analysis is that adjustment for confounding variables was limited in many of the component studies and was not uniform across studies. Moreover, too few patients were taking nonaspirin antiplatelet drugs or dual antiplatelet therapies to allow confident conclusions about different antiplatelet regimens. Nevertheless, this report serves to remind us that antiplatelet drugs — including aspirin — are not necessarily benign and should be prescribed only for valid and nonarbitrary reasons.