A recent analysis of hospital registry data suggests that people hospitalized for intracranial hemorrhage who had taken multiple antiplatelet medications, or medications stronger than aspirin, faced a higher risk of dying before discharge compared to those not on any antiplatelet medication. The findings are from a preliminary study set to be presented at the American Stroke Association's International Stroke Conference 2026 in New Orleans.
Antiplatelet drugs are used to prevent blood clots by reducing platelet stickiness and are commonly prescribed for heart attack and ischemic stroke prevention. Aspirin is the most widely used mild antiplatelet, but some patients receive additional, more potent agents such as clopidogrel, prasugrel, or ticagrelor after certain cardiovascular events.
Researchers examined data spanning ten years from over 400,000 adults in the United States who were hospitalized with non-traumatic brain bleeds and were treated at hospitals participating in the American Heart Association's Get With The Guidelines-Stroke Registry. Patients on anticoagulant therapy were excluded from this analysis. Outcomes were considered unfavorable if patients died or entered hospice care; favorable outcomes included discharge home or transfer to another care setting.
Of the 426,481 individuals studied, 109,512 had been taking one antiplatelet drug prior to their brain bleed, 17,009 had been on two antiplatelets, and 300,558 had not received any antiplatelet treatment before hospitalization.
Jonathan Rosand, M.D., M.Sc., FAHA—an American Stroke Association volunteer expert and professor of neurology at Harvard—commented: "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. 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 health care professional to ensure they are still right for you. If your health care professional advises you to continue, it likely means they are helping you more than they are harming you."
Study author Murthy noted: "These results do not imply that people should be reluctant to take antiplatelet medications if recommended. 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 analyze the risk of having a brain bleed from different antiplatelet medications. And with more research, these results may help inform how antiplatelet-associated intracranial hemorrhage 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."
Current clinical guidelines do not recommend platelet transfusions for patients experiencing brain bleeds while on one or more antiplatelets unless immediate surgery is needed. Further research could clarify whether platelet transfusions influence outcomes differently depending on whether patients were using single or dual therapies.
The study has limitations because it did not account for details such as the size or location of the hemorrhage within brain tissue or involvement of fluid-filled cavities—factors which could affect severity and patient prognosis.
According to projections by the American Heart Association for 2026 statistics on heart disease and stroke in the U.S., about 10% of all strokes nationwide result from intracranial hemorrhage.
