Efficacy And Safety Of Starting Antiplatelet Therapy In Patients With,spontaneous Intracerebral Hemorrhage:A Meta-analysis

Objective:Patients with spontaneous intracerebral hemorrhage(ICH)often have indications for antiplatelet therapy(APT).While,the risks and benefits of initially starting or restarting APT for these patients remain controversial in clinical practice.This meta-analysis was performed to explore the efficacy and safety of starting APT in patients with spontaneous ICH.Methods:This study was performed according to the statements recommended by Meta-Analysis of Observational Studies in Epidemiology(MOOSE)and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis(PRISMA).Relevant studies that published in online databases including PubMed,Embase,Cochrane Library,CBM,and CNKI and registered on ClinicalTrials.gov were systematically retrieved from the inception of each database to December 31,2021.Meanwhile,the references of the literature that were read in the full text also were retrieved.Stata16.0 software was used for data statistical analysis.Results:In this study,eight cohort studies and one randomized controlled trial(RCT)were included in meta-analysis.There was no significant statistical difference in the overall risks of hemorrhagic events(including ICH recurrence and other major bleeding events)between group of starting APT and not starting APT group in patients with spontaneous ICH(hazard ratio[HR]=1.05;95%confidence interval[CI]:0.89-1.24;P=0.56).Further subgroup analyses based on different median started time(within 3 months versus[vs.]more than 3 months),range of including hemorrhagic events(ICH recurrence vs.major bleeding events)and median follow-up time(within 2.5 years vs.more than 2.5 years)all did not find significant differences among subgroups.Similarly,the overall risks of occlusive vascular events did not have significant statistical difference between group of starting APT and not starting APT group(HR=0.90;95%CI:0.75-1.08;P=0.24).Further subgroup analysis based on different range of including occlusive vascular events found insignificant statistical difference in the risks of composite endpoint of ischemic cardiovascular and cerebrovascular events(major including ischemic stroke,transient ischemic attack,and acute coronary syndrome etc.)+thromboembolic events between two groups(HR=0.99;95%CI:0.80-1.22;P=0.930).Nevertheless,there was a significant statistical difference in the risks of ischemic cardiovascular and cerebrovascular events between two groups(HR=0.67;95%CI:0.46-0.96;P=0.03).In addition,the overall risks of death events did not have significant statistical difference between group of starting APT and not starting APT group(HR=0.88;95%CI:0.76-1.03;P=0.11).Conclusion:Starting APT significantly reduced the occurrence risks of ischemic cardiovascular and cerebrovascular events major including ischemic stroke,transient ischemic attack,and acute coronary syndrome etc in patients with spontaneous ICH.While,it did not increase the occurrence risks of hemorrhagic events including ICH recurrence and other major bleeding events in these patients.In addition,starting APT did not significantly affect occurrence risks of death events in patients with spontaneous ICH.