Aspirin Reduces New-Onset Strokes, Not Mortality of Tubercular Meningitis

Study investigators conducted a systematic review to evaluate the efficacy and safety of aspirin as an adjunctive therapy in patients with tubercular meningitis.

A systematic review and meta-analysis failed to find evidence that aspirin reduced mortality risk among patients with tubercular meningitis, according to study findings published in EClinicalMedicine.

Study researchers from the Postgraduate Institute of Medical Education and Research in India searched publication databases through October of 2019 for studies of aspirin use among patients with tubercular meningitis. This analysis included 3 randomized controlled trials comprising 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 doses of aspirin were 75 mg (n=47) and 81 mg (n=39), the high doses were 100 mg/kg/day (n=49) and 1000 mg (n=40), and the single-arm study used a dose of 150 mg (n=59).

The composite outcome of mortality and new-onset stroke risk was not significantly different among the aspirin and placebo cohorts (hazard ratio [HR], 0.86; 95% CI, 0.60-1.24; P =.43; I2, 0%).

Compared with patients given placebo, patients administered aspirin were not associated with decreased mortality risk (HR, 0.78; 95% CI, 0.45-1.35; P =.37; I2, 2%). On the other hand, patients receiving aspirin had significantly reduced risk for new-onset stroke (HR, 0.51; 95% CI, 0.29-0.87; P =.01; I2, 0%).

Among only pediatric patients, a trend similar to that of the entire patient population was observed.

Aspirin was associated with decreased risk for new-onset stroke (HR, 0.45; 95% CI, 0.25-0.80; P =.006; I2, 0%) but not for mortality (P =.52) or the composite outcome (P =.48).

The studies reported that aspirin was generally well tolerated. One of the studies, however, did report an aspirin-related death after an intercranial hemorrhage.

This study was limited by the scarcity of data on aspirin use among patients with tubercular meningitis and by one of the studies not reporting detailed safety outcomes.

These data indicated that aspirin was not effective for reducing mortality among patients with tubercular meningitis but did have a protective effect against new-onset stroke.


Rohilla R, Shafiq N, Malhotra S. Efficacy and safety of aspirin as an adjunctive therapy in tubercular meningitis: a systematic review and meta-analysis. EClinicalMedicine. 2021;34:100819. doi:10.1016/j.eclinm.2021.100819