Antiplatelet therapy for aneurysmal subarachnoid haemorrhage

Sanne Dorhout Mees; Walter M van den Bergh; Ale Algra; Gabriel JE Rinkel

doi:10.1002/14651858.CD006184.pub2

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Analysis 1.1

Comparison 1 Poor outcome, Outcome 1 Poor outcome, according to type of medication.

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Analysis 1.2

Comparison 1 Poor outcome, Outcome 2 Poor outcome, according to start of study medication.

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Analysis 2.1

Comparison 2 Case fatality, Outcome 1 Case fatality, according to type of medication.

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Analysis 2.2

Comparison 2 Case fatality, Outcome 2 Case fatality, according to start of study medication.

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Analysis 3.1

Comparison 3 Secondary ischaemia, Outcome 1 Clinical signs of secondary ischaemia.

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Analysis 3.2

Comparison 3 Secondary ischaemia, Outcome 2 Infarction on CT.

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Analysis 4.1

Comparison 4 Intracranial haemorrhagic complications, Outcome 1 Intracranial hemorrhagic complications according to type of medication.

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Analysis 4.2

Comparison 4 Intracranial haemorrhagic complications, Outcome 2 Intracranial haemorrhagic complications according to start of study medication.

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Analysis 5.1

Comparison 5 Rebleeding, Outcome 1 Rebleeding according to type of medication.

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Comparison 1. Poor outcome

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Poor outcome, according to type of medication Show forest plot	7	997	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.62, 1.01]

1.1 Acetylsalicylic acid	3	264	Risk Ratio (M‐H, Fixed, 95% CI)	0.81 [0.51, 1.28]
1.2 Cataclot/OKY‐046	2	280	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.54, 1.44]
1.3 Dipyridamole	1	320	Risk Ratio (M‐H, Fixed, 95% CI)	0.86 [0.57, 1.29]
1.4 Ticlopidine	1	133	Risk Ratio (M‐H, Fixed, 95% CI)	0.37 [0.14, 0.98]
2 Poor outcome, according to start of study medication Show forest plot	7	997	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.62, 1.01]

2.1 Start study medication before aneurysm treatment	2	373	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.62, 1.25]
2.2 Start study medication after aneurysm treatment	5	624	Risk Ratio (M‐H, Fixed, 95% CI)	0.72 [0.51, 1.02]

Comparison 1. Poor outcome

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Comparison 2. Case fatality

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Case fatality, according to type of medication Show forest plot	7	1354	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.74, 1.37]

1.1 Acetylsalicylic acid	3	264	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.49, 1.93]
1.2 Cataclot/OKY‐046	2	280	Risk Ratio (M‐H, Fixed, 95% CI)	1.17 [0.57, 2.41]
1.3 Dipyridamole	1	677	Risk Ratio (M‐H, Fixed, 95% CI)	1.12 [0.74, 1.71]
1.4 Ticlopidine	1	133	Risk Ratio (M‐H, Fixed, 95% CI)	0.35 [0.10, 1.23]
2 Case fatality, according to start of study medication Show forest plot	7	1354	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.74, 1.37]

2.1 Start study medication before aneurysm treatment	2	730	Risk Ratio (M‐H, Fixed, 95% CI)	1.10 [0.74, 1.64]
2.2 Start study medication after aneurysm treatment	5	624	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.54, 1.45]

Comparison 2. Case fatality

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Comparison 3. Secondary ischaemia

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Clinical signs of secondary ischaemia Show forest plot	4	368	Risk Ratio (M‐H, Fixed, 95% CI)	0.79 [0.53, 1.16]

1.1 Acetylsalicylic acid	2	211	Risk Ratio (M‐H, Fixed, 95% CI)	1.34 [0.76, 2.34]
1.2 Cataclot/OKY‐046	1	24	Risk Ratio (M‐H, Fixed, 95% CI)	0.53 [0.24, 1.15]
1.3 Dipyridamole	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.4 Ticlopidine	1	133	Risk Ratio (M‐H, Fixed, 95% CI)	0.39 [0.17, 0.86]
2 Infarction on CT Show forest plot	3	395	Risk Ratio (M‐H, Fixed, 95% CI)	0.85 [0.66, 1.08]

2.1 Acetylsalicylic acid	2	211	Risk Ratio (M‐H, Fixed, 95% CI)	1.06 [0.76, 1.48]
2.2 Cataclot/OKY‐046	1	184	Risk Ratio (M‐H, Fixed, 95% CI)	0.64 [0.44, 0.92]
2.3 Dipyridamole	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.4 Ticlopidine	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 3. Secondary ischaemia

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Comparison 4. Intracranial haemorrhagic complications

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Intracranial hemorrhagic complications according to type of medication Show forest plot	5	839	Risk Ratio (M‐H, Fixed, 95% CI)	1.36 [0.59, 3.12]

1.1 Acetylsalicylic acid	2	211	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.19, 4.76]
1.2 Cataclot/OKY‐046	2	280	Risk Ratio (M‐H, Fixed, 95% CI)	1.55 [0.48, 5.02]
1.3 Dipyridamole	1	348	Risk Ratio (M‐H, Fixed, 95% CI)	1.52 [0.26, 8.97]
1.4 Ticlopidine	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Intracranial haemorrhagic complications according to start of study medication Show forest plot	5	839	Risk Ratio (M‐H, Fixed, 95% CI)	1.36 [0.59, 3.12]

2.1 Start study medication before aneurysm treatment	1	348	Risk Ratio (M‐H, Fixed, 95% CI)	1.52 [0.26, 8.97]
2.2 Start study medication after aneurysm treatment	4	491	Risk Ratio (M‐H, Fixed, 95% CI)	1.31 [0.51, 3.37]

Comparison 4. Intracranial haemorrhagic complications

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Comparison 5. Rebleeding

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Rebleeding according to type of medication Show forest plot	2	838	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.70, 1.38]

1.1 Acetylsalicylic acid	1	161	Risk Ratio (M‐H, Fixed, 95% CI)	1.70 [0.44, 6.57]
1.2 Cataclot/OKY‐046	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.3 Dipyridamole	1	677	Risk Ratio (M‐H, Fixed, 95% CI)	0.94 [0.67, 1.33]
1.4 Ticlopidine	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 5. Rebleeding

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