People who experience a brain bleed while taking multiple antiplatelet medications or stronger agents than aspirin are significantly more likely to die in the hospital, according to preliminary research presented at the American Stroke Association's International Stroke Conference 2026. The study, based on a decade of data from the Get With The Guidelines-Stroke Registry, analyzed outcomes for 426,481 adults hospitalized with intracranial hemorrhage between 2011 and 2021.
Researchers compared patients who were taking no antiplatelet drugs before the bleed with those on aspirin alone, a single stronger antiplatelet (such as clopidogrel, prasugrel, or ticagrelor), or dual antiplatelet therapy (typically aspirin plus a stronger agent). The findings revealed that patients on stronger antiplatelet medications, either alone or in combination, had an increased risk of dying in the hospital compared to those on no antiplatelet therapy. In contrast, patients taking only aspirin had no higher risk of death and were actually less likely to have an unfavorable outcome, defined as death or discharge to hospice.
“Previous research assessing the relationship between antiplatelet therapy and patient outcomes after a brain bleed has grouped all the medications together,” said lead 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 study included 109,512 patients on a single antiplatelet, 17,009 on two antiplatelets, and 300,558 not on any antiplatelet therapy. After adjusting for demographic factors, other vascular conditions, stroke severity, and hospital characteristics, the researchers found that stronger antiplatelet use was linked to worse outcomes. The results highlight the need for individualized risk assessment when prescribing these medications, which are commonly used to prevent heart attacks and ischemic strokes.
American Stroke Association volunteer expert Jonathan Rosand, M.D., M.Sc., FAHA, emphasized that the findings do not mean patients should avoid antiplatelet drugs if recommended. “Using dual antiplatelet therapy and new generation antiplatelet drugs has improved the lives of many people with coronary artery disease,” Rosand said. “However, there are risks involved. This new study shows that if a stroke occurs while on these treatments, it is more likely to be fatal.” Rosand, a professor of neurology at Harvard and founder of the Global Brain Care Coalition, advised patients to check with their healthcare professional to ensure the medications remain appropriate.
The study’s authors note that current guidelines do not recommend platelet transfusions for antiplatelet-associated brain bleeds unless surgery is needed. Future research should examine whether such transfusions could improve outcomes differently for patients on single versus dual therapy. The study is limited by lacking details on bleed characteristics, such as volume and location, which could influence severity.
Intracranial hemorrhage accounts for about 10% of all strokes in the U.S., according to the American Heart Association’s 2026 Heart Disease and Stroke Statistics. The findings were presented as an abstract and are considered preliminary until published in a peer-reviewed journal.
