Aspirin, Anti-Clotting Meds Safe After Bleeding Stroke: Study

Taking aspirin or anti-clotting medicines like Plavix won’t boost the risk of another stroke if you’ve already survived a bleeding stroke, a new study suggests.

In fact, they might even help guard against a second brain bleed, the researchers noted.

The findings “are reassuring for survivors of brain hemorrhage who need to take antiplatelet [anti-clotting] medicines to prevent heart attacks and strokes. I am keen to [further] investigate the possibility that these medicines might halve the risk of brain hemorrhage happening again,” said study author Rustam Salman, from the Center for Clinical Brain Sciences at the University of Edinburgh, in Scotland.

Anti-clotting medicines are often prescribed to older people to reduce their risk of heart attack and another type of stroke caused by a blood clot (ischemic stroke).

But there have been concerns that these drugs might increase the risk of another bleeding stroke in people who’d already had one.

In this study, the researchers followed 537 bleeding stroke survivors for up to five years. During that time, half took anti-clotting medicines while half did not.

A second brain bleed occurred in 12 of those who took anti-clotting medicines and in 23 people who did not take the drugs, the investigators found.

This suggests that anti-clotting drugs reduce, rather than increase as feared, the chances of more bleeding in the brain, though further studies are needed to confirm this, the researchers said.

One stroke expert said the findings delivered good news.

“The important take away from this study is that there was no significant difference between the groups in the rate of recurrent intracranial hemorrhage or major hemorrhagic events,” said Dr. Andrew Rogove, medical director of stroke services at Northwell Health’s Southside Hospital in Bay Shore, N.Y.

The researchers also found that taking anti-clotting drugs was not more hazardous for patients who’d had microbleeds in the brain, which can be a warning sign of future strokes.

Metin Avkiran is associate medical director at the British Heart Foundation. “Around a third of people who suffer a brain hemorrhage, also known as hemorrhagic stroke, do so when they are taking an antiplatelet medicine such as aspirin to reduce the risk of a heart attack or an ischemic stroke,” he said in a university news release.

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

Rogove noted that there were some limitations to the study, namely that the majority of patients were male, white and over the age of 70.

“Despite these limitations, these results are encouraging as many patients require antiplatelet therapy following [a bleeding stroke], and this study provides evidence that it is safe, albeit in a limited population,” he said.

The British Heart Foundation-funded study was to be presented Wednesday at the European Stroke Organization Conference in Milan and published simultaneously in The Lancet and The Lancet Neurology journals.

More information

The American Heart Association has more on anti-clotting drugs.