Data from: Association between aspirin dose and subarachnoid hemorrhage from saccular aneurysms: a case-control study

Objective: We aimed to determine the association between ruptured saccular aneurysms and aspirin use/aspirin dose. Methods: 4,701 patients who were diagnosed at the Massachusetts General Hospital and Brigham and Women’s Hospital between 1990 and 2016 with 6,411 unruptured and ruptured saccular intracranial aneurysms were evaluated. Univariable and multivariable logistic regression analyses were performed to determine the association between aSAH and aspirin use, including aspirin dose. Inverse probability weighting using propensity scores was used to adjust for potential differences in baseline characteristics between cases and controls. Additional analyses were performed to examine the association of aspirin use and re-rupture prior to treatment. Results: In multivariate analysis with propensity score weighting, aspirin use (OR 0.60, 95% CI 0.45-0.80) was significantly associated with decreased risk of ruptured intracranial aneurysms. There was a significant inverse dose-response relationship between aspirin dose and aneurysmal subarachnoid hemorrhage (OR 0.65, 95% CI 0.53-0.81). In contrast, there was a significant association between aspirin use and increased risk of re-rupture prior to treatment (OR 8.15, 95% CI 2.22-30.0). Conclusions: In this large case-control study, aspirin therapy at diagnosis was associated with a significantly decreased risk of subarachnoid hemorrhage, with an inverse dose-response relationship among aspirin users. However, once rupture has occurred, aspirin is associated with an increased risk of re-rupture prior to treatment.

研究目的：本研究旨在明确破裂性囊状动脉瘤与阿司匹林使用情况及阿司匹林剂量之间的关联。
研究方法：本研究纳入1990年至2016年间于麻省总医院（Massachusetts General Hospital）和布里格姆妇女医院（Brigham and Women’s Hospital）确诊的4701例患者，共计6411个未破裂及破裂性囊状颅内动脉瘤。采用单变量及多变量逻辑回归分析，探究动脉瘤性蛛网膜下腔出血（aneurysmal subarachnoid hemorrhage, aSAH）与阿司匹林使用（含阿司匹林剂量）之间的关联。通过倾向得分（propensity scores）逆概率加权法（inverse probability weighting），校正病例组与对照组基线特征间的潜在差异。此外，本研究还开展了额外分析，以考察阿司匹林使用与治疗前动脉瘤再破裂之间的关联。
研究结果：在经倾向得分加权的多变量分析中，阿司匹林使用（比值比OR=0.60，95%置信区间CI=0.45~0.80）与颅内动脉瘤破裂风险的显著降低存在显著关联。阿司匹林剂量与动脉瘤性蛛网膜下腔出血之间存在显著的负向剂量-反应关系（OR=0.65，95%CI=0.53~0.81）。与之相反，阿司匹林使用与治疗前动脉瘤再破裂风险的显著升高存在关联（OR=8.15，95%CI=2.22~30.0）。
研究结论：本项大型病例对照研究显示，确诊时的阿司匹林治疗与蛛网膜下腔出血风险的显著降低相关，且在阿司匹林使用者中存在负向剂量-反应关系。然而，一旦发生动脉瘤破裂，阿司匹林则与治疗前再破裂风险的升高相关。