Analysis of hospital registry data reveals that people hospitalized for bleeding in the brain who had been taking multiple antiplatelet medications or stronger agents like clopidogrel were more likely to die before discharge, compared to those not on any antiplatelet therapy. The findings, presented at the American Stroke Association’s International Stroke Conference 2026, suggest that the type and number of antiplatelet drugs taken prior to a brain bleed significantly influence outcomes.
The study, led by Santosh Murthy, M.D., M.P.H., an associate professor of neurology and neuroscience at Weill Cornell Medicine in New York City, analyzed data from 426,481 adults (average age 67; 53% men) hospitalized for intracranial hemorrhage between 2011 and 2021. The data came from hospitals participating in the Get With The Guidelines-Stroke Registry. Patients on anticoagulants were excluded. Researchers categorized pre-bleed antiplatelet use into none, aspirin only, single stronger antiplatelet (e.g., clopidogrel, prasugrel, ticagrelor), or dual therapy (aspirin plus a stronger agent). The primary outcome was in-hospital death or discharge to hospice versus a favorable discharge to home or other care setting.
Among the cohort, 300,558 patients were not on any antiplatelet, 109,512 were on aspirin alone, and 17,009 were on two antiplatelet medications. After adjusting for demographics, comorbidities, stroke severity, and hospital characteristics, the researchers found that patients taking aspirin alone had no increased risk of in-hospital death compared to those on no antiplatelet therapy, and aspirin was actually associated with lower odds of an unfavorable outcome. In contrast, patients on a stronger antiplatelet agent, either alone or in combination with aspirin, had a significantly higher risk of dying in the hospital. There was also a trend toward increased risk of unfavorable outcomes with stronger or dual therapy.
“Previous research assessing the relationship between antiplatelet therapy and patient outcomes after a brain bleed has grouped all the medications together,” Murthy explained. “We conducted this study to find out if different antiplatelet medications or combinations affect overall death and recovery.” The results challenge the common practice of lumping all antiplatelet drugs together when assessing risk after intracranial hemorrhage.
Jonathan Rosand, M.D., M.Sc., FAHA, an American Stroke Association volunteer expert and professor of neurology at Harvard, noted, “This new study shows that if a stroke occurs while on these treatments, it is more likely to be fatal. If you’re on these medications, check with your health care professional to ensure they are still right for you.” Rosand was not involved in the study but emphasized that the findings do not mean patients should avoid antiplatelet therapy when prescribed, as the benefits often outweigh the risks. Currently, guidelines do not recommend platelet transfusions for antiplatelet-associated brain bleeds unless surgery is needed, but Murthy suggested future research should explore whether transfusions might benefit patients on dual or stronger therapy.
The study is limited by its retrospective design and lack of detailed data on bleed characteristics such as location or volume. However, it provides important insights for clinicians managing patients with intracranial hemorrhage, highlighting the need for individualized risk assessment based on pre-bleed antiplatelet regimen. The findings are considered preliminary until published in a peer-reviewed journal.
