Published Online
on July 24, 2003

A more recent version of this article appeared on September 1, 2003

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Submitted on March 11, 2003
Accepted on April 17, 2003

Antiplatelet Therapy in Aneurysmal Subarachnoid Hemorrhage. A Systematic Review

Sanne M. Dorhout Mees MD; Gabriel J.E. Rinkel MD, FAHA^*; Jeannette W. Hop MD; Ale Algra MD, FAHA; and Jan van Gijn MD, FRCP, FRCPE

From the Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience (S.M.D.M., G.J.E.R., J.W.H., A.A., J. van G.), and the Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands.

^* To whom correspondence should be addressed. E-mail: g.j.e.rinkel{at}neuro.azu.nl.

Background and Purpose--Observational studies suggest that platelet inhibitors reduce the risk of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage and thereby have a beneficial effect on clinical outcome. Robust evidence, however, is lacking. We performed a systematic meta-analysis to determine whether antiplatelet therapy has a beneficial effect after SAH.

Methods--We searched Medline and the Cochrane Library to identify all randomized controlled trials of antiplatelet drugs versus control and calculated relative risks with corresponding 95% confidence intervals (CIs) for poor outcome (dependence or death), the occurrence of DCI, and the occurrence of any intracranial hemorrhage.

Results--We included 5 trials totaling 699 patients. The overall relative risk for poor outcome was 0.87 (95% CI, 0.65 to 1.17); for the occurrence of DCI (reported in 3 of the 5 studies), 0.65 (95% CI, 0.47 to 0.89); and for the occurrence of intracranial hemorrhage, 1.19 (reported in 4 of the 5 studies) (95% CI, 0.76 to 1.85).

Conclusions--Our data indicate that antiplatelet drugs reduce the risk of DCI in patients with subarachnoid hemorrhage. A randomized clinical trial is warranted to assess the effect on overall outcome.

Key words: aneurysm • antiplatelet therapy • subarachnoid hemorrhage

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