{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T06:18:29Z","timestamp":1792736309446,"version":"4.5.0"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,3,19]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              A comprehensive literature search was conducted in PubMed, Web of Science, and Scopus databases, following Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses guidelines. Nine single\u2010center, nonrandomized cohort studies involving 2709 patients were included. Outcomes were analyzed using random\u2010effects model, and a network meta\u2010analysis 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\u20130.7];\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001). In addition, the use of antithrombotic therapy was associated with lower risk of intracranial hemorrhage from a cerebral cavernous malformation on follow\u2010up (OR, 0.21 [95% CI, 0.13\u20130.35];\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001). A network meta\u2010analysis revealed a nonsignificant OR of 0.73 (95% CI, 0.23\u20132.56) when antiplatelet therapy was compared with anticoagulant therapy.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">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\u2010generating and not definitive for clinical practice change.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.123.032910","type":"journal-article","created":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T02:07:55Z","timestamp":1710295675000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Antithrombotic Therapy in Cerebral Cavernous Malformations: A Systematic Review, Meta\u2010Analysis, and Network Meta\u2010Analysis"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4910-6090","authenticated-orcid":false,"given":"Basel","family":"Musmar","sequence":"first","affiliation":[{"name":"Department of Neurosurgery Duke University Hospital Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5208-8425","authenticated-orcid":false,"given":"Hamza","family":"Salim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Louisiana State University Hospital Shreveport LA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihad","family":"Abdelgadir","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Duke University Hospital Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5648-8816","authenticated-orcid":false,"given":"Samantha","family":"Spellicy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Duke University Hospital Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8668-7629","authenticated-orcid":false,"given":"Nimer","family":"Adeeb","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Louisiana State University Hospital Shreveport LA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Zomorodi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Duke University Hospital Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan","family":"Friedman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Duke University Hospital Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1510-602X","authenticated-orcid":false,"given":"Issam","family":"Awad","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery The University of Chicago Medicine Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8965-2413","authenticated-orcid":false,"given":"Pascal M.","family":"Jabbour","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Thomas Jefferson University Hospital Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8335-5442","authenticated-orcid":false,"given":"David M.","family":"Hasan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Duke University Hospital Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1227\/00006123-199310000-00001"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b3016"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(07)70053-4"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002701"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.3171\/2011.3.FOCUS1165"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.3171\/2016.3.JNS152419"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(15)00303-8"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2021-328658"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(16)00039-9"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.3171\/2018.1.JNS172547"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.3171\/2012.8.JNS112050"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.112.668533"},{"key":"e_1_3_1_14_2","doi-asserted-by":"crossref","unstructured":"Wityk RJ Chik Y Hoffberger J. Risk of bleeding from antithrombotic agents (AT) in patients with cerebral cavernous malformations (CCMs). Abstract presented at: American Academy of Neurology 66th Annual Meeting; April 8 2014; Philadelphia PN USA. Neurology. 2014;82 P2.102. https:\/\/www.neurology.org\/doi\/10.1212\/WNL.82.10_supplement.P2.102","DOI":"10.1212\/WNL.82.10_supplement.P2.102"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(19)30231-5"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-015-0091-1"},{"key":"e_1_3_1_19_2","unstructured":"Flemming K. Special considerations (pregnancy anticoagulation) and future research. Abstract presented at: Fourth Bellaria Neurovascular Conference Cavernous malformations of the brain and spinal cord: from basic sciences to advanced neurosurgical techniques; November 16 2018; Bologna Italy."},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2020.04.012"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1227\/neu.0000000000002480"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1159\/000529511"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2007.132316"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-005-0994-8"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2006.113753"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000069018.90456.C9"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surneu.2007.06.081"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2009.04.008"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.3171\/2023.7.FOCUS23117"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1159\/000507789"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.005132"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.123.032910","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T12:22:11Z","timestamp":1715602931000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.123.032910"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,19]]},"references-count":30,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024,3,19]]}},"alternative-id":["10.1161\/JAHA.123.032910"],"URL":"https:\/\/doi.org\/10.1161\/jaha.123.032910","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,19]]},"assertion":[{"value":"2023-11-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-04","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-12","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e032910"}}