Large trial says aspirin safe for brain bleed stroke patients

Author: Adrian O'Dowd

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People who experience a stroke caused by brain haemorrhage can take common medicines such as aspirin without raising their risk of another stroke, suggests a study* published yesterday in The Lancet.

Researchers said the findings of their large clinical trial were reassuring for the thousands of people who take the medicines to reduce their risk of heart attack and another common type of stroke caused by blood clots in the brain.

These treatments – known as antiplatelet medicines – work by slowing or stopping blood from clotting and are often prescribed to older people because they can lower the risk of heart attack and stroke caused by a blood clot.

Doctors had thought the medicines – which include aspirin and clopidogrel – might make people with stroke due to brain haemorrhage more likely to suffer another bleed in the brain.

To investigate this, researchers led by the University of Edinburgh tracked outcomes from 537 people from across the UK who had suffered a brain haemorrhage while they were taking medicines to stop blood clotting.

Patients were randomly assigned to either start taking antiplatelet treatment or avoid it for up to five years between 2013 and 2018.

The team found that people who took antiplatelet medicines experienced fewer recurrences of brain haemorrhage compared with those who did not take the treatments.

Some 12 people suffered a brain bleed while taking the medication compared with 23 people who did not.

The researchers said this could mean the treatments reduce rather than increase risk of further bleeding in the brain, but added that further studies were needed to confirm this.

Around half of the participants underwent an additional brain scan using MRI at the beginning of the study to check for the presence of microbleeds, which can be a warning sign of future strokes.

The researchers found treatment with antiplatelet medication was not more hazardous for people who already had microbleeds in their brain.

The study, called RESTART (REstart or STop Antithrombotics Randomised Trial), was funded by the British Heart Foundation and the findings are being presented at the European Stroke Organisation Conference being held this week in Milan.

Professor Rustam Salman of University of Edinburgh’s Centre for Clinical Brain Sciences, said: “The results of the RESTART trial are reassuring for survivors of brain haemorrhage who need to take antiplatelet medicines to prevent heart attacks and strokes. I am keen to investigate the possibility that these medicines might halve the risk of brain haemorrhage happening again.”

Professor Metin Avkiran, associate medical director at the British Heart Foundation, said: “Around a third of people who suffer a haemorrhagic stroke do so when they are taking an antiplatelet medicine such as aspirin to reduce the risk of a heart attack or an ischaemic stroke.

“We now have a strong indication they can carry on taking these potentially life-saving medicines after the brain haemorrhage without increasing the risk of another one, which is crucial new information for both patients and doctors.”


*RESTART Collaboration. Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial (May 2019). DOI: 10.1016/S0140-6736(19)30840-2.

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