Aspirin Use Safe After Intracerebral Hemorrhage

A new study suggests that antiplatelet agents such as aspirin do not increase the risk of a further recurrence following an intracerebral hemorrhage (ICH).

The study included 127 patients with lobar ICH and 80 with deep ICH who had been treated at Massachusetts General Hospital (Boston, MA, USA) between 1994 and 2004 and were interviewed at three and six months post ICH and every six months thereafter. The results were reported in the January 24, 2006, issue of Neurology.

Forty-six of the subjects began using aspirin, or in one case clopidogrel, during follow-up. Indications included ischemic heart disease, atrial fibrillation, artificial heart valve, ischemic stroke, and transient ischemic attack. There were 39 subjects with recurrent ICH. Analyses showed that antiplatelet agents were not associated with a significantly increased risk of recurrent hemorrhage among lobar ICH survivors or deep ICH survivors.

"These data suggest that antiplatelet therapy may be used in selected ICH survivors without a substantial increase in the risk of recurrent ICH,” wrote Dr. E. E. Smith and colleagues. "It remains prudent for antiplatelet therapy to be considered only in selected ICH survivors at high risk for thrombotic diseases.”

However, they cautioned that physicians may have avoided antiplatelet use in subjects perceived to be at higher risk of recurrence, which could lead to an underestimate of the risk involved.



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