Antiplatelet use after intracerebral hemorrhage. Neurology. 2006;66:206-09.
The authors reviewed data from consecutive survivors of primary intracerebral hemorrhage (ICH) enrolled in a single-center prospective cohort study. The study included 127 patients with lobar ICH and 80 with deep ICH who had been treated at Massachusetts General Hospital, Boston, between 1994 and 2004, then interviewed at 3 and 6 months post-ICH and every 6 months thereafter. Among the subjects, 46 began using aspirin, or in one case, clopidogrel, during follow-up. Indications included ischemic heart disease, atrial fibrillation, artificial heart valve, or ischemic stroke or transient ischemic attack. There were 39 subjects with recurrent ICH. Univariate analyses showed that antiplatelet exposure was not associated with a significantly increased risk of recurrent hemorrhage among lobar ICH survivors (hazard ratio 0.8, p = 0.73) or deep ICH survivors (HR 1.2, p = 0.88). The authors suggest that antiplatelet therapy may be used in selected ICH survivors without a substantial increase in the risk of recurrent ICH. However, they warn that clinicians may have avoided antiplatelet use in subjects perceived to be at higher risk of recurrence, which could lead to an underestimate of risk.