Abstract TP030: MANAGEMENT OF ACUTE ISCHEMIC STROKE IN BACTERIAL MENINGITIS: A SCOPING REVIEW

Background: Bacterial meningitis remains a global public health concern. In 2019, there were an estimated 236,000 deaths and 2.51 million (2.11-2.99) incident cases due to meningitis globally, with the greatest burden in children younger than 5 years. Ischemic stroke can occur in up to 14-25 % of individuals with acute bacterial meningitis and is associated with poor prognosis and higher mortality. Despite the high burden, there is a lack of robust evidence regarding primary or secondary prevention of stroke due to acute bacterial meningitis. Objective: To search for evidence for use of antithrombotic agents for primary or secondary prevention of stroke due to acute bacterial meningitis. Methodology: We searched PubMed, Cochrane, and OVID/EMBASE from their inception to July 2025 for studies reporting the use of antithrombotic agents for prevention or management of ischemic stroke after bacterial meningitis. Studies with hemorrhagic stroke, CVST, animal or in vitro studies, viral meningitis, non-infectious causes of stroke, along with studies in languages other than English, were excluded. Data was extracted on population, management, and outcomes. Results: 28 studies met inclusion criteria (n studies: adults = 13, children = 7, both = 8). Study designs included 2 systematic reviews, 5 randomized controlled trials, 1 prospective cohort study, 5 retrospective reviews, 5 expert reviews, and 10 case reports and series that discussed use of antithrombotic agents for the treatment of acute ischemic infarction associated in bacterial meningitis. Only 6 randomized trials were found, mostly for TB meningitis and 1 for pneumococcal meningitis. Reported management strategies included antiplatelet agent (aspirin, clopidogrel or both) (n= 17), LMWH or UFH only (n=2), aspirin with heparin (n=3), thrombolytics (n= 5). Heterogeneity in interventions and outcome reporting precluded meta-analysis. Conclusion: Evidence on management of ischemic stroke in bacterial meningitis remains scarce and heterogeneous. Randomized trials are limited to tuberculous meningitis. Most available data come from case reports and small series, highlighting the absence of standardized approaches. Reported complications from the use of antithrombotic agents are uncommon, suggesting some benefits in preventing ischemic events. Further studies are urgently needed to inform evidence-based guidelines for both pediatric and adult populations.