An analysis of hospital registry data has found that people who were hospitalised due to bleeding in the brain and had taken multiple antiplatelet medications, or medications stronger than aspirin, were more likely to die before leaving the hospital compared to those not taking any antiplatelet medication, according to a preliminary study set to be presented at the 2026 International Stroke Conference (ISC; 4–6 February, New Orleans, USA).
“Previous research assessing the relationship between antiplatelet therapy and patient outcomes after a brain bleed has grouped all the medications together,” said lead study author Santosh Murthy (Weill Cornell Medicine, New York City, USA). “We conducted this study to find out if different antiplatelet medications or combinations affect overall death and recovery in people with a brain bleed.”
Researchers analysed a decade of data for more than 400,000 adults in the USA who were hospitalised for a brain bleed—also known as an intracranial haemorrhage (ICH)—without a traumatic brain injury or any other type of stroke, and received care at a hospital participating in the American Heart Association’s (AHA) Get With The Guidelines-Stroke registry from 2011–2021. Patients who were on anticoagulant medication were excluded. Short-term outcomes were considered ‘unfavourable’ if a patient died or was sent to hospice care versus ‘favourable’ if a patient was discharged home or to another care setting.
Among 426,481 people hospitalised with ICH (average age, 67 years; 53% men), 109,512 were taking only one antiplatelet and 17,009 were taking two antiplatelet medications, while 300,558 did not receive any antiplatelet treatment before their brain bleed. The researchers relay that they used multiple logistic regression to examine the relationship between various types and numbers of antiplatelet medications, with results being adjusted for demographic factors; other vascular conditions that might influence both the use of antiplatelet medications and the risk of a poor outcome after a brain bleed; brain bleed severity on the National Institutes of Health stroke scale (NIHSS); use of a ventricular drain; and hospital characteristics.
They found that, when compared to patients with no pre-ICH antiplatelet therapy, patients taking aspirin alone did not have an increased risk of dying in the hospital and aspirin was associated with lower odds of an unfavourable outcome. Additionally, patients taking a stronger antiplatelet medication—either alone or in combination with aspirin—had an increased risk of death in the hospital versus those receiving no antiplatelet therapy beforehand. There was also a trend towards patients who were taking stronger antiplatelet medications or dual therapy having an increased risk of an unfavourable outcome compared to those taking no pre-ICH antiplatelet medications, according to the researchers.
“Using dual antiplatelet therapy and new-generation antiplatelet drugs has improved the lives of many people with coronary artery disease. However, there are risks involved,” commented American Stroke Association (ASA) volunteer expert Jonathan Rosand (Massachusetts General Hospital, Boston, USA), who was not involved in this study. “Patients on these medications have a slightly higher chance of having a bleeding stroke. This new study shows that, if a stroke occurs while on these treatments, it is more likely to be fatal. If you’re on these medications, check with your healthcare professional to ensure they are still right for you. If your healthcare professional advises you to continue, it likely means they are helping you more than they are harming you.”
“These results do not imply that people should be reluctant to take antiplatelet medications if recommended,” Murthy added. “The findings of our study show that, if patients have a brain bleed, the type of antiplatelet medication they were taking before the bleed may affect their risk of death or other severe outcomes. It is important to note that we did not analyse the risk of having a brain bleed from different antiplatelet medications—and, with more research, these results may help inform how antiplatelet-associated intracranial haemorrhage is managed in the hospital. Currently, antiplatelet medications are discontinued immediately after a bleed. Another option may be giving patients transfusions of donor platelets to lower the bleeding risk.”
As detailed by the ASA, current guidelines do not recommend platelet transfusions for patients with bleeding in the brain if they are taking one or more antiplatelet medications, unless they need immediate surgery.
The researchers note that the current study is limited by the fact that it did not consider specific ICH characteristics, such as the amount of blood, or the location within the brain tissue where the bleed was located and if it involved the fluid-filled cavities in the brain. These measures could help gauge the severity of a brain bleed and how each might influence patient outcomes, the researchers add, also commenting that future studies should examine whether platelet transfusions affect outcomes differently after brain bleeds in patients who were taking single or dual antiplatelet therapies.
