An analysis of a decade of hospital registry data reveals that people who experience a brain bleed while taking multiple antiplatelet medications or stronger agents such as clopidogrel, prasugrel, or ticagrelor are more likely to die in the hospital compared to those not on any antiplatelet therapy. The findings, considered preliminary until published in a peer-reviewed journal, were presented at the American Stroke Association’s International Stroke Conference 2026.
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 hospitalized for intracranial hemorrhage (ICH) between 2011 and 2021. Patients were treated at hospitals participating in the Get With The Guidelines-Stroke Registry. Of these, 109,512 were taking only aspirin, 17,009 were on two antiplatelet medications, and 300,558 were not on any antiplatelet therapy before the bleed.
After adjusting for demographics, vascular risk factors, stroke severity, and hospital characteristics, the researchers found that patients taking aspirin alone did not have an increased risk of dying in the hospital and actually had lower odds of an unfavorable outcome (death or discharge to hospice) compared to those on no antiplatelet therapy. However, patients taking a stronger antiplatelet medication, either alone or in combination with aspirin, had a significantly increased risk of in-hospital death. There was also a trend toward higher risk of unfavorable outcomes in these groups.
“Previous research assessing the relationship between antiplatelet therapy and patient outcomes after a brain bleed has grouped all the medications together. We conducted this study to find out if different antiplatelet medications or combinations affect overall death and recovery in people with a brain bleed,” Murthy said in a statement.
American Stroke Association volunteer expert Jonathan Rosand, M.D., M.Sc., FAHA, emphasized that the findings do not mean patients should avoid antiplatelet medications if prescribed. “Using dual antiplatelet therapy and new generation antiplatelet drugs has improved the lives of many people with coronary artery disease. However, there are risks involved. 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,” said Rosand, a professor of neurology at Harvard and founder of the Global Brain Care Coalition, who was not involved in the study.
Current guidelines do not recommend platelet transfusions for patients with ICH on antiplatelet therapy unless immediate surgery is needed. The study’s authors suggest future research should examine whether platelet transfusions could improve outcomes differently in patients on single versus dual antiplatelet therapy. “These results open the door to research on how to improve care for people hospitalized with a brain bleed who have been taking antiplatelet medications,” Murthy noted.
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 study’s limitations include not accounting for specific characteristics of the bleed, such as volume or location, which could influence outcomes.
