Antithrombotic Therapy in Cerebral Cavernous Malformations: A Systematic Review, Meta-Analysis, and Network Meta-Analysis

Background: Cerebral cavernous malformations (CCMs) 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.

Objectives: This study aims to clarify the association between antithrombotic therapy-including antiplatelet and anticoagulant medications-and the risk of intracranial hemorrhage in patients with CCMs.

Methods: A comprehensive literature search was conducted in PubMed, Web of Science, and Scopus databases, following PRISMA guidelines. Nine single-center, nonrandomized cohort studies involving 2,709 patients were included. Outcomes were analyzed using random-effects model, and a network meta-analysis was conducted for further insight.

Results: Of the 2,709 patients studied, 388 were on antithrombotic therapy. Patients on antithrombotic therapy had a lower risk presenting with intracranial hemorrhage (OR: 0.56; 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 CCM on follow-up (OR: 0.21; CI: 0.13–0.35, p < 0.0001). A network meta-analysis revealed a nonsignificant OR of 0.73 (CI: 0.23–2.56) when antiplatelet therapy was compared to anticoagulant therapy.

Conclusion: Our study explores the potential benefits of antithrombotic therapy in CCMs. 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 ([Figs. 1]–[3]).

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Artikel online veröffentlicht:
05. Februar 2024