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 death before discharge compared to those not on any antiplatelet therapy. 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 without traumatic brain injury or other stroke types.
Antiplatelet medications, which prevent blood clot formation by making platelets less sticky, are commonly prescribed to treat and prevent heart attacks and ischemic strokes. While aspirin is a mild anti-clotting medication often used for stroke prevention, stronger alternatives like clopidogrel, prasugrel, and ticagrelor are sometimes prescribed alongside aspirin after cardiovascular events. 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 how different medications or combinations affect mortality and recovery.
The research utilized 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 only one antiplatelet, 17,009 were on two antiplatelet medications, and 300,558 had no antiplatelet treatment before the bleed. Outcomes were categorized as unfavorable if a patient died or was sent to hospice care versus favorable if discharged home or to another care setting.
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. In contrast, those on stronger antiplatelet medications, either alone or combined with aspirin, showed an increased risk of in-hospital death. There was also a trend toward higher unfavorable outcomes in these groups. 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 those with coronary artery disease, they carry risks, including a slightly higher chance of bleeding strokes that may be more fatal.
Murthy clarified that the results do not suggest people should avoid antiplatelet medications if recommended, but rather highlight how pre-bleed medication types may influence outcomes. The study did not analyze the risk of having a brain bleed from different antiplatelet medications. Current guidelines do not recommend platelet transfusions for brain bleed patients on antiplatelet medications unless immediate surgery is needed, but future research could explore whether transfusions affect outcomes differently based on therapy type. The study's limitations include not accounting for specific brain bleed characteristics like blood amount or location, which could influence severity and 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. The findings open the door to research on improving care for hospitalized brain bleed patients on antiplatelet medications, potentially informing management strategies beyond current practices of discontinuing medications post-bleed. As stroke remains a leading cause of death, this study underscores the need for tailored treatment approaches in high-risk scenarios.
