A systematic review and meta-analysis found no evidence that aspirin reduced the risk of mortality in patients with tuberculous meningitis, according to study results published in EClinicalMedicine.
Study researchers at the Postgraduate Institute for Medical Education and Research in India searched publication databases for studies on aspirin use in patients with tuberculous meningitis until October 2019. This analysis included 3 randomized controlled trials with 365 patients.
Patients were randomly assigned to receive placebo (n = 150) or aspirin. Two of the studies had a low and high dose arm. The low aspirin doses were 75 mg (n = 47) and 81 mg (n = 39), the high doses 100 mg / kg / day (n = 49) and 1000 mg (n = 40) and the single dose In the arm study, a dose of 150 mg (n = 59) was used.
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The composite result of mortality and emerging stroke risk did not differ significantly between the aspirin and placebo cohorts (hazard ratio) [HR]0.86; 95% CI, 0.60-1.24; P = 0.43; I2, 0%).
Compared to patients given placebo, patients given aspirin were not associated with a reduced risk of mortality (HR 0.78; 95% CI 0.45-1.35; P = 0.37; I2 2% ). On the other hand, patients who received aspirin had a significantly reduced risk of a new stroke (HR 0.51; 95% CI 0.29-0.87; P = 0.01; I2 0%).
Only in pediatric patients was a trend similar to that observed in the total patient population.
Aspirin was associated with a reduced risk of new stroke (HR 0.45; 95% CI 0.25-0.80; P = 0.006; I2 0%) but not for mortality (P = 0.52) or the composite result (P. = 0.48).
The studies reported that aspirin was generally well tolerated. However, one of the studies reported aspirin-related death after an intercranial hemorrhage.
This study was limited by the lack of data on aspirin use in patients with tuberculous meningitis and by one of the studies that did not report detailed safety results.
These data showed that aspirin was not effective in reducing mortality in patients with tuberculous meningitis, but it did protect against emerging stroke.
reference
Rohilla R, Shafiq N, Malhotra S. Efficacy and safety of aspirin as adjunctive therapy for tuberculous meningitis: a systematic review and meta-analysis. EClinicalMedicine. 2021; 34: 100819. doi: 10.1016 / j.eclinm.2021.100819
