| Background:Patients with acute ischemic stroke(AIS)combined with unruptured intracranial aneurysm(UIA)need to bear certain bleeding risks while treating acute ischemic stroke.Antiplatelet therapy is the main method for treating acute ischemic stroke at present.Whether the risk of rupture of intracranial aneurysm(IA)will increase in the treatment remains to be studied.Aspirin is the representative drug of antiplatelet therapy,and also a typical non-steroidal anti-inflammatory drugs(NAIDS).Some studies have shown that the use of aspirin has a protective relationship with subarachnoid hemorrhage(SAH)or the opposite results,and some studies have not found the relationship between the two.Therefore,it needs further study.Objective:1.To explore the correlation between aspirin use and SAH risk through meta-analysis.2.To study the safety of antiplatelet therapy in patients with AIS and UIA.Methods:1.The study on the relationship between aspirin and SAH was retrieved by computer system until February 18,2023.All included studies used the Newcastle-Ottawa Scale(NOS)to evaluate the quality of the literature.The data of SAH risk of aspirin and non-aspirin users were used to generate Odds Ratio(OR)and 95%confidence intervals(CI).I~2 test was used to evaluate heterogeneity(0～100%).I~2 values of 25%,50%and 75%corresponded to low,medium and high heterogeneity respectively,p<0.05 was considered statistically significant.2.The patients who were hospitalized in the department of neurology of China-Japan Union Hospital of Jilin University from June 2019 to June 2021 and diagnosed as AIS with UIA were included in the retrospective study.The baseline data of patients and the characteristic data of aneurysms were collected,and the patients were divided into antiplatelet treatment group and non-antiplatelet treatment group.The adverse events of patients within 3 months and 6 months were followed up,including SAH caused by IA rupture,intracranial hemorrhage and recurrence of ischemic stroke.Results:1.Meta-analysis included 13 studies with 876687 participants,including 13860cases of SAH.A meta-analysis of 13 included studies found that aspirin use was associated with the risk of SAH(OR=0.69,95%CI:0.50～0.95,p=0.023),and there was a high heterogeneity between these studies(I~2=95.2%).According to the different study population,the study population is divided into general population and IA population;In the general population,patients taking aspirin have a slightly higher risk of SAH(OR=1.17,95%CI:1.01～1.36,p=0.023).In the IA population,the use of aspirin was associated with the reduction of SAH risk(OR=0.39,95%CI:0.25～0.61,p<0.001).2.This study included 103 patients with AIS and UIA who met the requirements,including 133 aneurysms.The research results show that AIS patients with UIA with or without antiplatelet drugs have no hemorrhagic adverse events in a short period of time(within 3 months or 6 months),including SAH caused by IA rupture and cerebral hemorrhage caused by non-IA rupture.There are 7 cases of ischemic adverse events.Conclusion:1.In the IA population,the use of aspirin has a significant relationship with the reduction of SAH risk,while in the general population,the risk of SAH using aspirin is slightly increased,and the results vary greatly among different populations.2.In the single-center study,the patients with AIS and UIA treated with antiplatelet drugs did not have bleeding adverse events in a short period(within 3months or 6 months). |
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