Skip to main navigation
Skip notifications
Access to POEMs and Essential Evidence Plus will no longer be included in CMA membership as of Dec. 1, 2023.
Search
Antiplatelet therapy vs no antiplatelet therapy after intracranial hemorrhage: similar rates of subsequent bleeds and major vascular events (RESTART)
Clinical Question
What are the benefits and harms of continued antiplatelet therapy in persons who have had an intracranial hemorrhage?
Bottom line
In this slightly underpowered study, starting antiplatelet therapy after an ICH does not appear to be more harmful than avoiding antiplatelet therapies. 2b
Reference
Study design: Randomized controlled trial (single-blinded)
Funding: Other
Setting: Outpatient (specialty)
Synopsis
This study included adults who survived at least 24 hours after an intracranial hemorrhage (ICH) and who had their antithrombic therapy discontinued. The patients were randomized to antiplatelet therapy (aspirin, dipyridamole, or clopidogrel as monotherapy or dual therapy; n = 268) or antiplatelet avoidance (n = 268). Although the allocation was concealed, only the research staff conducting follow-up and those assessing outcome events were masked to group assignment. The study was set up so that all survivors had at least 2 years of follow-up. After a median 7 years of follow-up, the rate of subsequent ICH was similar for those receiving antiplatelet therapy as for those who were not (9.3% vs 8.2%). Additionally, the authors found no statistically significant difference in the rate of major vascular events (26.8% vs 32.5%). Since the study was designed to recruit 720 patients, this report may lack the power to detect these differences. This is less of a concern since the rate of subsequent ICH was lower for those treated with antiplatelet agents (a counterintuitive result); but for a high-risk group, the rate of major vascular events is potentially important (number needed to treat = 18). Finally, these data are comparable with findings from observational studies.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Comments
Seems counterintuitive.
Seems counterintuitive to continue anti-platelet agent after hemorrhagic stroke.
No
None
Discrediting the use of antiplatelet therapy such as aspirin
In my opinion the use of aspirin is being discredited likely buy the push of the pharmaceutical companies to feature the new oral anticoagulants/Doacs in future for this role. I think that’s a biased towards using he’s more expensive drugs in the place of something that has been used for the last almost 100 years.
intracranial bleeding
At present time I do only consult but in my active practice giving any kind of anticoagulant to patient with acute intracranial bleeding was contraindicated if patient was on warfarin that has to be neutralised with fresh frozen plasma.
Risks and Benefits
This study addresses only risks. The practice of medicine is based on the benefit/risk ratio of an intervention, not just risks. this publication will not change my practice.
ICH and antiplatelet agents afterward
no increase in ICH while on antiplatelet agent