Abstract
Background
Antiplatelet drug–associated intracranial hemorrhage has a high mortality rate, and many factors can cause antiplatelet drug–associated intracranial hemorrhage. Until now, systematic reviews and assessments of the certainty of the evidence have not been published.
Aim
We conducted a systematic review to identify risk factors of antiplatelet drug–associated intracranial hemorrhage.
Method
The protocol for this systematic review was prospectively registered with PROSPERO (CRD42022311647). All studies written in English that met the inclusion criteria published before January 2022 were obtained from PubMed, EMBASE, Web of Science, and Cochrane Library. Two researchers independently screened articles, extracted data, and evaluated the quality and evidence of the included studies. Risk factors for antiplatelet drug–associated intracranial hemorrhage were used as the outcome index of this review. Random or fixed-effect models were used in statistical methods. I2 statistics were used to evaluate heterogeneity.
Results
Of 2844 citations, we included 6 studies in our analysis. For intracranial hemorrhage, moderate-certainty evidence showed a probable association with race, low BMI, GCS, severe bleeding, headache or vomiting, cerebrovascular disease, lacunar small vessel disease, cardiovascular disease, blood sugar, blood pressure, CT-defined white matter hypodensity, antihypertensive drugs, and antiplatelet therapy. In addition, we found low-certainty evidence that there may be little to no association between risk of intracranial hemorrhage and age, sex, and dual antithrombotic treatment or anticoagulant. CT-defined white matter hypodensity is not included in most intracranial hemorrhage risk assessment models.
Conclusion
This study summarizes risk factors for antiplatelet drug–associated intracranial hemorrhage, which is significant in preventing intracranial hemorrhage.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Saloheimo P, Ahonen M, Juvela S et al (2006) Regular aspirin-use preceding the onset of primary intracerebral hemorrhage is an independent predictor for death. Stroke 37:129–133
Hart RG, Tonarelli SB, Pearce LA (2005) Avoiding central nervous system bleeding during antithrombotic therapy. Recent data and ideas. Stroke 36:1588–1593
Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF (2001) Spontaneous intracerebral hemorrhage. N Engl J Med 344:1450–1460
Broderick J, Connolly S, Feldmann E et al (2007) Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke 38:2001–2023
Rosand J, Eckman MH, Knudsen KA, Singer DE, Greenberg SM (2004) The effect of warfarin and intensity of anticoagulation on outcome of intracerebral hemorrhage. Arch Intern Med 164:880–884
McQuaid KR, Laine L (2006) Systematic review and metaanalysis of adverse events of low-dose aspirin and clopidogrel in randomized controlled trials. Am J Med 119:624–638
Toyoda K, Yasaka M, Iwade K et al (2008) Dual antithrombotic therapy increases severe bleeding events in patients with stroke and cardiovascular disease: a prospective, multicenter, observational study. Stroke 39:1740–1745
Darzi AJ, Karam SG, Charide R et al (2020) Prognostic factors for VTE and bleeding in hospitalized medical patients: a systematic review and meta-analysis. Blood 135(20):1788–1810
Riley RD, Moons KG, Snell KI, Ensor J, Hooft L, Altman DG et al (2019) A guide to systematic review and meta-analysis of prognostic factor studies. BMJ 364:k4597
Wolff RF, Moons KGM, Riley RD et al (2019) PROBAST: a tool to assess the risk of bias and applicability of prediction model studies. Ann Intern Med 170(1):51–58
Tang SW, Zhang Y, Tao BL, Yang ZR, Sun F, Zhan SY (2018) Risk of bias assessment: (7) assessing bias in studies of prognostic factors [in Chinese]. Zhong hua Liu Xing Bing Xue Za Zhi 39(7):1003–1008
Hayden JA, van der Windt DA, Cartwright JL, Côté P, Bombardier C (2013) Assessing bias in studies of prognostic factors. Ann Intern Med 158(4):280–286
Reeves BC, Deeks JJ, Higgins JPT, Wells GA (2008) Including non-randomized studies. In: Cochrane handbook for systematic reviews of interventions 1:391
Iorio A, Spencer FA, Falavigna M et al (2015) Use of GRADE for assessment of evidence about prognosis: rating confidence in estimates of event rates in broad categories of patients. BMJ 350:h870
Ahn S, Fessler JA (2003) Standard errors of mean, variance, and standard deviation estimators. Ann Arbor: Electrical Engineering and Computer Science Department, The University of Michigan, pp 1–2
Grant RL (2014) Converting an odds ratio to a range of plausible relative risks for better communication of research findings. BMJ 348(1):f7450
Wang Z (2013) Converting odds ratio to relative risk in cohort studies with partial data information. J Stat Softw 55(5):1–11
Ariesen MJ, Algra A, Warlow CP, Rothwell PM (2006) Cerebrovascular Cohort Studies Collaboration (CCSC). Predictors of risk of intracerebral haemorrhage in patients with a history of TIA or minor ischaemic stroke. J Neurol Neurosurg Psychiatry 77(1):92–94
Moustafa F, Roubin J, Pereira B et al (2018) Predictive factors of intracranial bleeding in head trauma patients receiving antiplatelet therapy admitted to an emergency department. Scand J Trauma Resusc Emerg Med 26(1):50
Amarenco P, Sissani L, Labreuche J et al (2017) The intracranial-B2LEED3S score and the risk of intracranial hemorrhage in ischemic stroke patients under antiplatelet treatment. Cerebrovasc Dis 43(3–4):145–151
Qiao M, Bi Q, Fu P, Wang Y, Song Z, Guo F (2017) Previous hypertensive hemorrhage increases the risk for bleeding and ischemia for PCI patients on dual antiplatelet therapy. Neurol Res 39(6):516–520
Gregoire SM, Jäger HR, Yousry TA, Kallis C, Brown MM, Werring DJ (2010) Brain microbleeds as a potential risk factor for antiplatelet-related intracerebral haemorrhage: hospital-based, case-control study. J Neurol Neurosurg Psychiatry 81(6):679–684
Biffi A, Halpin A, Towfighi A et al (2010) Aspirin and recurrent intracerebral hemorrhage in cerebral amyloid angiopathy. Neurology 75(8):693–698
Acknowledgements
ZZW and CJN initiated the study. ZZW, CJN, CMR, and MFX performed data extraction and analyses and drafted the first version of the manuscript. CJN, LMN, and ZJH critically reviewed the manuscript and revised it. All authors made a substantial contribution to the concept and design of the study, interpreted the data, and reviewed the manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
None.
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Zeng, Z., Chen, J., Chen, M. et al. Risk factors for antiplatelet drug–associated intracranial hemorrhage: a systematic review and meta-analysis. Neurol Sci 43, 6761–6769 (2022). https://doi.org/10.1007/s10072-022-06326-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10072-022-06326-y