Analysis of hospital registry data spanning a decade found that individuals hospitalized for bleeding in the brain who had been taking multiple antiplatelet medications, or medications stronger than aspirin, faced a higher likelihood of death before hospital 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 without traumatic brain injury or other stroke types.
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 only one antiplatelet, 17,009 were taking two antiplatelet medications, and 300,558 received 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.
The findings indicated 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 taking a stronger antiplatelet medication, either alone or in combination with aspirin, had an increased risk of death in the hospital. There was also a trend toward increased risk of unfavorable outcomes for patients on stronger antiplatelet 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 strokes that may be more fatal.
Murthy clarified that the results do not suggest people should avoid antiplatelet medications if recommended, but rather highlight that the type of medication taken before a brain bleed may influence mortality risk. The study did not analyze the risk of having a brain bleed from different antiplatelet medications. Current guidelines do not recommend platelet transfusions for patients with brain bleeds on antiplatelet medications unless immediate surgery is needed, but future research could explore whether such transfusions affect outcomes differently based on single or dual therapy use.
The study’s limitations include not considering specific characteristics of the brain bleed, such as the amount of blood 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. Researchers used multiple logistic regression to adjust for demographic factors, vascular conditions, brain bleed severity, and hospital characteristics, ensuring a comprehensive analysis.
This research opens the door to further studies on improving care for patients hospitalized with brain bleeds who have been taking antiplatelet medications, potentially informing hospital management strategies. As stroke remains a significant health concern, with it being the #4 leading cause of death in the U.S., these findings underscore the importance of personalized medication approaches and ongoing evaluation of treatment risks and benefits in clinical practice.
