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For some, aspirin doesn't increase risk of recurring hemorrhagic stroke

January 24, 2006

Aspirin is typically prescribed for people at risk of having an ischemic stroke to prevent blood clots. Because aspirin may cause bleeding, it is typically avoided in people who have had a hemorrhagic stroke, also called intracerebral hemorrhage. A new study, however, finds that aspirin may not increase the risk of recurrent intracerebral hemorrhage. The study is published in the January 24, 2006 issue of Neurology, the scientific journal of the American Academy of Neurology (AAN).

Researchers followed 207 survivors of intracerebral hemorrhage at regular intervals to check whether they took an antiplatelet drug such as aspirin and if it increased their risk of another hemorrhage. In an intracerebral hemorrhage, a blood vessel bursts within the brain resulting in a pressure buildup that can lead to unconsciousness or death.

Out of 46 people who had aspirin treatment at some point during follow-up, seven had a recurrent intracerebral hemorrhage. Aspirin was prescribed to prevent ischemic heart disease in half of the group. No cases were reported where nonprescription aspirin was taken without a doctor's recommendations. There were 32 others who also had a recurrent intracerebral hemorrhage but didn't take any aspirin.

"We observed no association between aspirin use and an increased risk of recurrent intracerebral hemorrhage," said lead author Anand Viswanathan, MD, PhD, a neurologist at Massachusetts General Hospital in Boston and a member of the AAN. "Aspirin could be a potentially useful strategy for improving the quality of life in certain intracerebral hemorrhage survivors who are at risk for ischemic stroke, but this should be confirmed in a randomized clinical trial."

Recurrent intracerebral hemorrhage is more common in survivors of a hemorrhage in the lobar region (cerebral cortex) than in deep brain structures (brainstem, thalamus, and striatum). Thirty-five out of 127 survivors of lobar hemorrhage had a recurrent hemorrhage, compared to four out of 80 survivors of deep hemorrhage. Yet aspirin use had no significant effect on the rate of recurrence after a hemorrhage in either location, according to the study.

In a related editorial, Larry B. Goldstein, MD, a neurologist at Duke University and the Duke Center for Cerebrovascular Disease and also a fellow of the AAN, wrote, "Despite the lack of demonstrable increased risk of recurrent intracranial bleeding in patients treated with platelet antiaggregants in this cohort, it is also uncertain whether the patients benefited from these drugs. Until additional data become available, the use of antiplatelet drugs in this setting should be restricted to highly selected patients with a compelling indication and a relatively low risk of recurrent hemorrhage."

American Academy of Neurology