{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T17:56:47Z","timestamp":1792519007697,"version":"4.5.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tubercular meningitis (TBM) remains a highly lethal form of extrapulmonary tuberculosis. Aspirin, owing to its anti-inflammatory and antithrombotic properties, has been explored as adjunctive therapy, but its clinical benefits remain controversial. This meta-analysis aimed to evaluate the efficacy and safety of adjunctive aspirin in TBM, particularly its impact on stroke and all-cause mortality, and to explore the influence of different aspirin dosages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We systematically searched four databases for randomized controlled trials (RCTs) comparing adjunctive aspirin versus standard anti-tuberculosis therapy (ATT) in TBM patients. Outcomes included stroke, all-cause mortality, and bleeding events. Random-effects meta-analyses were conducted to pool risk ratios (RRs) with 95% confidence intervals (CIs). A network meta-analysis (NMA) was performed to assess the effect of different aspirin doses. The quality of evidence was assessed using the GRADE framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Five RCTs involving 580 participants were included. Adjunctive aspirin significantly reduced the risk of stroke (RR: 0.56; 95% CI: 0.33\u20130.95), with low-dose aspirin showing superior protective effect compared to high-dose in NMA. However, aspirin did not reduce all-cause mortality (RR: 1.00; 95% CI: 0.65\u20131.55) or increase bleeding risk. Sensitivity analysis indicated limited robustness of stroke outcomes, and overall evidence quality ranged from low to very low.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Adjunctive low-dose aspirin may reduce the risk of stroke in TBM without increasing bleeding events, although it has no clear effect on mortality. Further high-quality trials are needed to confirm the optimal dosing strategy and long-term benefits of aspirin in TBM management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:uri>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420251110022<\/jats:uri>\n                      , identifier CRD420251110022.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1682144","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T06:26:56Z","timestamp":1762324016000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Effects of aspirin on stroke and mortality in tubercular meningitis: a meta-analysis of randomized controlled 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