Patients hospitalized for brain bleeds who were taking multiple antiplatelet medications or drugs stronger than aspirin before the event had increased risk of in-hospital death compared to those not taking any antiplatelet medication, according to preliminary research to be presented at the American Stroke Association's International Stroke Conference 2026. The study analyzed data from more than 400,000 adults treated for intracranial hemorrhage between 2011 and 2021 at U.S. hospitals participating in the American Heart Association's Get With The Guidelines-Stroke Registry.
Among 426,481 people hospitalized with intracranial hemorrhage, researchers found that 109,512 were taking only one antiplatelet medication, 17,009 were taking two antiplatelet medications, while 300,558 did not receive any antiplatelet treatment before the brain bleed. The analysis revealed that patients taking aspirin alone did not have an increased risk of dying in the hospital, and aspirin was actually associated with lower odds of an unfavorable outcome. However, patients taking stronger antiplatelet medications—either alone or in combination with aspirin—had significantly increased risk of death during hospitalization.
"Previous research assessing the relationship between antiplatelet therapy and patient outcomes after a brain bleed has grouped all the medications together," said lead study author Santosh Murthy, M.D., M.P.H., an associate professor of neurology and neuroscience at Weill Cornell Medicine in New York City. "We conducted this study to find out if different antiplatelet medications or combinations affect overall death and recovery in people with a brain bleed."
The findings have important implications for clinical practice, particularly as intracranial hemorrhage accounts for approximately 10% of all strokes in the U.S., according to the American Heart Association's 2026 Heart Disease and Stroke Statistics. American Stroke Association volunteer expert Jonathan Rosand, M.D., M.Sc., FAHA, noted that while dual antiplatelet therapy and newer generation antiplatelet drugs have improved outcomes for many people with coronary artery disease, "patients on these medications have a slightly higher chance of having a bleeding stroke. This new study shows that if a stroke occurs while on these treatments, it is more likely to be fatal."
Researchers emphasized that the results do not suggest patients should avoid antiplatelet medications when recommended by healthcare professionals. Instead, the study opens the door to research on how to improve care for people hospitalized with brain bleeds who have been taking antiplatelet medications. Currently, antiplatelet medications are discontinued immediately after a bleed, but researchers suggest platelet transfusions might be an alternative approach worth investigating. Current guidelines do not recommend platelet transfusions for patients with bleeding in the brain if they are taking one or more antiplatelet medications unless they need immediate surgery.
The study has limitations, including that it did not consider specific characteristics of the brain bleed, such as the amount of blood or location in the brain tissue, which could influence patient outcomes. Additionally, the research is preliminary and has not yet undergone peer review. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal. The study will be presented at the American Stroke Association's International Stroke Conference 2026 in New Orleans, February 4-6, 2026.
