Aspirin ok for brain bleed stroke patients

People who suffer a stroke caused by bleeding in the brain – known as brain haemorrhage – can take common medicines without raising their risk of another stroke, a major clinical trial has found.

Researchers say the findings are 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.

Antiplatelet medicines

These everyday treatments – known as antiplatelet medicines – work by slowing or stopping blood from clotting.

They are often prescribed to older people because they can lower risk of heart attack and stroke caused by a blood clot.

Risk fears

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.

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.

Haemorrhage

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

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

This may suggest the treatments reduce rather than increase risk of further bleeding in the brain, the researchers say, but further studies are needed to confirm this.

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 Rustam Salman
Centre for Clinical Brain Sciences

Brain scans

Around half of the participants underwent an additional brain scan using MRI at the beginning of the study.

These scans are often used by doctors to check for the presence of tiny blood deposits in the brain, known as 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.

Reassurance

Experts say this provides further reassurance that brain haemorrhage survivors can safely continue to take antiplatelet medicines to reduce their risk of future heart attacks or strokes.

It also suggests that patients do not need to undergo an MRI scan before starting treatment. This is important because older people are often unable to have an MRI.

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.
Professor Metin Avkiran
Associate Medical Director at the British Heart Foundation

The study - called RESTART - is published in The Lancet and The Lancet Neurology. It was funded by the British Heart Foundation. Findings are being presented at the European Stroke Organisation Conference in Milan.