Analysis of hospital registry data spanning a decade indicates that individuals hospitalized for bleeding in the brain who were taking multiple antiplatelet medications or medications stronger than aspirin faced a higher likelihood of dying before discharge compared to those not taking any antiplatelet medication. The preliminary study, to be presented at the American Stroke Association's International Stroke Conference 2026, examined data from over 400,000 adults in the U.S. hospitalized for intracranial hemorrhage.
Antiplatelet medications, prescribed to prevent blood clot formation, are commonly used in treating and preventing heart attacks and ischemic strokes. Aspirin is a mild anti-clotting medication, while stronger options include clopidogrel, prasugrel, and ticagrelor. Lead study author Santosh Murthy, M.D., M.P.H., noted that previous research grouped all antiplatelet therapies together when assessing outcomes after brain bleeds, prompting this investigation into whether different medications or combinations affect mortality and recovery.
Researchers analyzed data from the American Heart Association's Get With The Guidelines-Stroke Registry, excluding patients on anticoagulant medication. Among 426,481 people hospitalized with intracranial hemorrhage, 109,512 were taking one antiplatelet, 17,009 were taking two, and 300,558 were on none before the bleed. Outcomes were classified as unfavorable if a patient died or was sent to hospice care versus favorable if discharged home or to another care setting.
The findings revealed that patients taking aspirin alone did not have an increased risk of dying in the hospital and actually had lower odds of an unfavorable outcome compared to those on no antiplatelet therapy. In contrast, patients taking a stronger antiplatelet medication, either alone or combined with aspirin, had an increased risk of in-hospital death. There was also a trend toward increased risk of unfavorable outcomes for those on stronger medications or dual therapy.
American Stroke Association volunteer expert Jonathan Rosand, M.D., M.Sc., FAHA, emphasized that while dual antiplatelet therapy and newer generation drugs have improved lives for many with coronary artery disease, they carry risks, including a slightly higher chance of bleeding stroke. This study shows that if a stroke occurs while on these treatments, it is more likely to be fatal. Rosand advised patients to consult healthcare professionals to ensure these medications remain appropriate, noting that if continued, the benefits likely outweigh the risks.
Murthy clarified that the results do not suggest people should avoid antiplatelet medications if recommended. Instead, they indicate that the type of antiplatelet medication taken before a brain bleed may influence death or severe outcome risks. The study did not analyze the risk of having a brain bleed from different antiplatelet medications. With more research, these results could inform how antiplatelet-associated intracranial hemorrhage is managed in hospitals, where current practice involves discontinuing medications immediately after a bleed. Another potential option is giving patients transfusions of donor platelets to reduce bleeding risk, though current guidelines only recommend this for those needing immediate surgery.
The study's limitations include not considering specific characteristics of the brain bleed, such as blood amount or location, which could influence outcomes. Intracranial hemorrhage accounts for about 10% of all strokes in the U.S., according to the American Heart Association's 2026 Heart Disease and Stroke Statistics. Future studies should examine whether platelet transfusions affect outcomes differently in patients after brain bleeds who were on single or dual antiplatelet therapies. The findings, while preliminary and not yet peer-reviewed, open the door to research on improving care for hospitalized brain bleed patients on antiplatelet medications, potentially impacting clinical guidelines and patient safety protocols worldwide.
