Antithrombotic Therapy in Cerebral Cavernous Malformations: A Systematic Review, Meta‐Analysis, and Network Meta‐Analysis
Background Cerebral cavernous malformations are complex vascular anomalies in the central nervous system associated with a risk of intracranial hemorrhage. Traditional guidelines have been cautious about the use of antithrombotic therapy in this patient group, citing concerns about potential bleedin...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-03-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.032910 |
| _version_ | 1797257423383166976 |
|---|---|
| author | Basel Musmar Hamza Salim Jihad Abdelgadir Samantha Spellicy Nimer Adeeb Ali Zomorodi Allan Friedman Issam Awad Pascal M. Jabbour David M. Hasan |
| author_facet | Basel Musmar Hamza Salim Jihad Abdelgadir Samantha Spellicy Nimer Adeeb Ali Zomorodi Allan Friedman Issam Awad Pascal M. Jabbour David M. Hasan |
| author_sort | Basel Musmar |
| collection | DOAJ |
| description | Background Cerebral cavernous malformations are complex vascular anomalies in the central nervous system associated with a risk of intracranial hemorrhage. Traditional guidelines have been cautious about the use of antithrombotic therapy in this patient group, citing concerns about potential bleeding risk. However, recent research posits that antithrombotic therapy may actually be beneficial. This study aims to clarify the association between antithrombotic therapy, including antiplatelet and anticoagulant medications, and the risk of intracranial hemorrhage in patients with cerebral cavernous malformations. Methods and Results A comprehensive literature search was conducted in PubMed, Web of Science, and Scopus databases, following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Nine single‐center, nonrandomized cohort studies involving 2709 patients were included. Outcomes were analyzed using random‐effects model, and a network meta‐analysis was conducted for further insight. Of the 2709 patients studied, 388 were on antithrombotic therapy. Patients on antithrombotic therapy had a lower risk of presenting with intracranial hemorrhage (odds ratio [OR], 0.56 [95% CI, 0.45–0.7]; P<0.0001). In addition, the use of antithrombotic therapy was associated with lower risk of intracranial hemorrhage from a cerebral cavernous malformation on follow‐up (OR, 0.21 [95% CI, 0.13–0.35]; P<0.0001). A network meta‐analysis revealed a nonsignificant OR of 0.73 (95% CI, 0.23–2.56) when antiplatelet therapy was compared with anticoagulant therapy. Conclusions Our study explores the potential benefits of antithrombotic therapy in cerebral cavernous malformations. Although the analysis suggests a possible role for antithrombotic agents, it is critical to note that the evidence remains preliminary. Fundamental biases in study design, such as ascertainment and assignment bias, limit the weight of our conclusions. Therefore, our findings should be considered hypothesis‐generating and not definitive for clinical practice change. |
| first_indexed | 2024-04-24T22:37:24Z |
| format | Article |
| id | doaj.art-ee0a3cd23eaf4f5da3f620219ae5056a |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-24T22:37:24Z |
| publishDate | 2024-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-ee0a3cd23eaf4f5da3f620219ae5056a2024-03-19T10:07:06ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-03-0113610.1161/JAHA.123.032910Antithrombotic Therapy in Cerebral Cavernous Malformations: A Systematic Review, Meta‐Analysis, and Network Meta‐AnalysisBasel Musmar0Hamza Salim1Jihad Abdelgadir2Samantha Spellicy3Nimer Adeeb4Ali Zomorodi5Allan Friedman6Issam Awad7Pascal M. Jabbour8David M. Hasan9Department of Neurosurgery Duke University Hospital Durham NC USADepartment of Neurosurgery Louisiana State University Hospital Shreveport LA USADepartment of Neurosurgery Duke University Hospital Durham NC USADepartment of Neurosurgery Duke University Hospital Durham NC USADepartment of Neurosurgery Louisiana State University Hospital Shreveport LA USADepartment of Neurosurgery Duke University Hospital Durham NC USADepartment of Neurosurgery Duke University Hospital Durham NC USADepartment of Neurosurgery The University of Chicago Medicine Chicago IL USADepartment of Neurosurgery Thomas Jefferson University Hospital Philadelphia PA USADepartment of Neurosurgery Duke University Hospital Durham NC USABackground Cerebral cavernous malformations are complex vascular anomalies in the central nervous system associated with a risk of intracranial hemorrhage. Traditional guidelines have been cautious about the use of antithrombotic therapy in this patient group, citing concerns about potential bleeding risk. However, recent research posits that antithrombotic therapy may actually be beneficial. This study aims to clarify the association between antithrombotic therapy, including antiplatelet and anticoagulant medications, and the risk of intracranial hemorrhage in patients with cerebral cavernous malformations. Methods and Results A comprehensive literature search was conducted in PubMed, Web of Science, and Scopus databases, following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Nine single‐center, nonrandomized cohort studies involving 2709 patients were included. Outcomes were analyzed using random‐effects model, and a network meta‐analysis was conducted for further insight. Of the 2709 patients studied, 388 were on antithrombotic therapy. Patients on antithrombotic therapy had a lower risk of presenting with intracranial hemorrhage (odds ratio [OR], 0.56 [95% CI, 0.45–0.7]; P<0.0001). In addition, the use of antithrombotic therapy was associated with lower risk of intracranial hemorrhage from a cerebral cavernous malformation on follow‐up (OR, 0.21 [95% CI, 0.13–0.35]; P<0.0001). A network meta‐analysis revealed a nonsignificant OR of 0.73 (95% CI, 0.23–2.56) when antiplatelet therapy was compared with anticoagulant therapy. Conclusions Our study explores the potential benefits of antithrombotic therapy in cerebral cavernous malformations. Although the analysis suggests a possible role for antithrombotic agents, it is critical to note that the evidence remains preliminary. Fundamental biases in study design, such as ascertainment and assignment bias, limit the weight of our conclusions. Therefore, our findings should be considered hypothesis‐generating and not definitive for clinical practice change.https://www.ahajournals.org/doi/10.1161/JAHA.123.032910antithromboticCCMcerebral cavernous malformationintracranial hemorrhage |
| spellingShingle | Basel Musmar Hamza Salim Jihad Abdelgadir Samantha Spellicy Nimer Adeeb Ali Zomorodi Allan Friedman Issam Awad Pascal M. Jabbour David M. Hasan Antithrombotic Therapy in Cerebral Cavernous Malformations: A Systematic Review, Meta‐Analysis, and Network Meta‐Analysis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease antithrombotic CCM cerebral cavernous malformation intracranial hemorrhage |
| title | Antithrombotic Therapy in Cerebral Cavernous Malformations: A Systematic Review, Meta‐Analysis, and Network Meta‐Analysis |
| title_full | Antithrombotic Therapy in Cerebral Cavernous Malformations: A Systematic Review, Meta‐Analysis, and Network Meta‐Analysis |
| title_fullStr | Antithrombotic Therapy in Cerebral Cavernous Malformations: A Systematic Review, Meta‐Analysis, and Network Meta‐Analysis |
| title_full_unstemmed | Antithrombotic Therapy in Cerebral Cavernous Malformations: A Systematic Review, Meta‐Analysis, and Network Meta‐Analysis |
| title_short | Antithrombotic Therapy in Cerebral Cavernous Malformations: A Systematic Review, Meta‐Analysis, and Network Meta‐Analysis |
| title_sort | antithrombotic therapy in cerebral cavernous malformations a systematic review meta analysis and network meta analysis |
| topic | antithrombotic CCM cerebral cavernous malformation intracranial hemorrhage |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.032910 |
| work_keys_str_mv | AT baselmusmar antithrombotictherapyincerebralcavernousmalformationsasystematicreviewmetaanalysisandnetworkmetaanalysis AT hamzasalim antithrombotictherapyincerebralcavernousmalformationsasystematicreviewmetaanalysisandnetworkmetaanalysis AT jihadabdelgadir antithrombotictherapyincerebralcavernousmalformationsasystematicreviewmetaanalysisandnetworkmetaanalysis AT samanthaspellicy antithrombotictherapyincerebralcavernousmalformationsasystematicreviewmetaanalysisandnetworkmetaanalysis AT nimeradeeb antithrombotictherapyincerebralcavernousmalformationsasystematicreviewmetaanalysisandnetworkmetaanalysis AT alizomorodi antithrombotictherapyincerebralcavernousmalformationsasystematicreviewmetaanalysisandnetworkmetaanalysis AT allanfriedman antithrombotictherapyincerebralcavernousmalformationsasystematicreviewmetaanalysisandnetworkmetaanalysis AT issamawad antithrombotictherapyincerebralcavernousmalformationsasystematicreviewmetaanalysisandnetworkmetaanalysis AT pascalmjabbour antithrombotictherapyincerebralcavernousmalformationsasystematicreviewmetaanalysisandnetworkmetaanalysis AT davidmhasan antithrombotictherapyincerebralcavernousmalformationsasystematicreviewmetaanalysisandnetworkmetaanalysis |