Analysis of hospital registry data reveals that people hospitalized for bleeding in the brain who had taken multiple antiplatelet medications, or medications stronger than aspirin, were more likely to die before leaving the hospital compared to those not taking any antiplatelet medication, according to a preliminary study to be presented at the American Stroke Association’s International Stroke Conference 2026.
The study, based on data from the American Heart Association’s Get With The Guidelines-Stroke Registry, analyzed more than 400,000 adults hospitalized for intracranial hemorrhage between 2011 and 2021. Among them, 109,512 were taking only one antiplatelet, 17,009 were taking two, and 300,558 were on none. Patients on anticoagulants were excluded.
Lead study author Santosh Murthy, M.D., M.P.H., an associate professor of neurology and neuroscience at Weill Cornell Medicine in New York City, noted that previous research grouped all antiplatelet therapies together. This study aimed to differentiate outcomes based on the type and number of medications.
The findings showed that patients taking aspirin alone did not have an increased risk of dying in the hospital and 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 in combination with aspirin, had an increased risk of death. There was also a trend toward increased risk of unfavorable outcomes with stronger or dual therapy.
American Stroke Association volunteer expert Jonathan Rosand, M.D., M.Sc., FAHA, commented that while dual antiplatelet therapy has improved outcomes for coronary artery disease, it carries risks. “If a stroke occurs while on these treatments, it is more likely to be fatal,” he said. Rosand advised patients to consult their healthcare professional to ensure the medications remain appropriate.
Murthy emphasized that the results do not imply patients should avoid antiplatelet medications if recommended. Rather, the type of medication taken before a bleed may affect outcomes. Current guidelines recommend discontinuing antiplatelet medications immediately after a bleed, and future research may explore whether platelet transfusions could benefit patients on stronger or multiple agents.
The study did not assess the risk of having a brain bleed from different antiplatelet medications, and it had limitations such as not considering specific characteristics of the bleed. 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 are considered preliminary until published in a peer-reviewed journal. The research highlights the need for personalized management of antiplatelet therapy in patients at risk for or experiencing a brain bleed.
