An analysis of more than a decade of hospital registry data reveals that people who suffer a brain bleed while taking multiple antiplatelet medications or drugs stronger than aspirin are more likely to die before leaving the hospital, according to preliminary research 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, included 426,481 adults hospitalized for intracranial hemorrhage between 2011 and 2021.
Antiplatelet medications, such as aspirin, clopidogrel, prasugrel, and ticagrelor, are commonly prescribed to prevent blood clots that cause heart attacks and ischemic strokes. However, their impact on outcomes after a brain bleed had not been clearly differentiated until now. “Previous research assessing the relationship between antiplatelet therapy and patient outcomes after a brain bleed has grouped all the medications together,” said 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. “We conducted this study to find out if different antiplatelet medications or combinations affect overall death and recovery.”
Among the patients analyzed, 109,512 were taking only one antiplatelet, 17,009 were on dual antiplatelet therapy, and 300,558 were not on any antiplatelet treatment before the bleed. After adjusting for demographic factors, vascular conditions, stroke severity, and hospital characteristics, the researchers found that patients taking aspirin alone did not have an increased risk of dying in the hospital compared to those on no antiplatelet therapy. In fact, aspirin was associated with lower odds of an unfavorable outcome (death or discharge to hospice). However, patients taking a stronger antiplatelet medication, either alone or in combination with aspirin, had a significantly increased risk of in-hospital 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, noted, “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. This new study shows that if a stroke occurs while on these treatments, it is more likely to be fatal.” Rosand emphasized that patients should not stop medications without consulting their healthcare professional, as the benefits may outweigh the risks. “If your health care professional advises you to continue, it likely means they are helping you more than they are harming you.”
Current guidelines do not recommend platelet transfusions for patients with brain bleeds on antiplatelet therapy unless immediate surgery is needed. The study authors suggest that future research should examine whether platelet transfusions could improve outcomes differently for patients on single versus dual antiplatelet therapy. “These results do not imply that people should be reluctant to take antiplatelet medications if recommended,” Murthy cautioned. “The findings 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.”
The study is limited by its lack of data on specific characteristics of the brain bleed, such as hematoma volume or location, which could influence severity. Nevertheless, the findings highlight the need for personalized management of antiplatelet therapy in the context of intracranial hemorrhage. The American Stroke Association’s 2026 Heart Disease and Stroke Statistics notes that intracranial hemorrhage accounts for about 10% of all strokes in the U.S., underscoring the importance of this research.
