颅内出血后重启抗血小板治疗的获益与风险Meta分析

Benefits and risks of resumption of antiplatelet therapy in patients after intracranial hemorrhage: a Meta-analysis

目的系统评价颅内出血后重启抗血小板治疗的获益与风险。方法以intracranial hemorrhages,intracerebral hemorrhages,brain hemorrhages,antiplatelet,restart,resumption等英文词汇计算机检索1990年1月1日-2018年6月1日美国国立医学图书馆生物医学信息检索系统(PubMed)、荷兰医学文摘(EMBASE/SCOPUS)、Cochrane图书馆等数据库收录的关于颅内出血后重启抗血小板治疗的病例对照研究或队列研究,采用Newcastle-Ottawa量表(NOS)和RevMan 5.2统计软件进行文献质量评价和Meta分析。结果共获得4403篇英文文献,经剔除重复和不符合纳入标准者,最终纳入12项高质量(NOS评分≥6分)临床研究共4191例颅内出血患者(重启抗血小板治疗组1325例,未重启抗血小板治疗组2866例)。Meta分析显示,与未重启抗血小板治疗相比,重启抗血小板治疗可以降低颅内出血患者缺血性血管事件发生率(RR=0.700,95%CI:0.570～0.850;P=0.001),但不增加颅内出血复发或血肿扩大风险(RR=0.830,95%CI:0.580～1.170;P=0.290)、血管性死亡事件风险(RR=1.300,95%CI:0.920～1.840;P=0.140)。结论颅内出血后重启抗血小板治疗可以降低缺血性血管事件风险,且不增加颅内出血复发或血肿扩大以及血管性死亡事件的风险。

Objective To assess the benefits and risks of resumption of antiplatelet therapy in patients after intracranial hemorrhage （ICH） by Meta-analysis. Methods Retrieve relevant case-control studies or cohort studies from online databases （January 1, 1990-June 1, 2018） as PubMed, EMBASE/ SCOPUS and Cochrane Online Library with key words： intracranial hemorrhages, intracerebral hemorrhages, brain hemorrhages, antiplatelet, restart, resumption. Selection of studies was performed according to predesigned inciusion and exclusion criteria. Quality of studies was evaluated by using Newcastle-Ottawa Scale （NOS）. All data were pooled by RevMan 5.2 software for Meta-analysis. Results The research enrolled 4403 articles, from which 12 high-quality （NOS ≥6 scores） studies were chosen after excluding duplicates and those not meeting the inclusion criteria. A total of 4191 cases （1325 cases with resumption of antiplatelet therapy and 2866 cases without resumption of antiplatelet therapy） were included. Metaanalysis showed that comparing with non-resumption of antiplatelet therapy, resumption of antiplatelet therapy was effective in reducing the incidence of ischemic vascular events （RR = 0.700, 95% CI： 0.570-0.850; P = 0.001）. There were no significant differences in the risk of ICH recurrence or hematoma expansion （RR = 0.830, 95%CI： 0.580-1.170; P = 0.290） and the incidence of vascular death （RR = 1.300, 95% CI： 0.920-1.840; P = 0.140） between patients with and without resumption of antiplatelet therapy. Conclusions Resumption of antiplatelet therapy in patients after primary ICH effectively reduced the risk of ischemic vascular events, without significant increase of risk of ICH recurrence or hematoma expansion and the occurrence of vascular death.