Aspirin may be safe after bleeding in the brain

NEW YORK (Reuters Health) - The results of a new study suggest that the use of drugs that prevent blood clotting, such as aspirin, does not raise the risk of repeat bleeding in patients who've have bleeding in the brain, a problem called intracerebral hemorrhage (ICH).

However, until more evidence becomes available, anticlotting treatment should be considered only in selected ICH survivors who have a high risk of clotting problems, the researchers advise.

The study included 207 patients with ICH who had been treated at Massachusetts General Hospital in Boston between 1994 and 2004 and interviewed three and six months after they had an ICH and every six months thereafter.

Dr. E. E. Smith and colleagues report in the medical journal Neurology that 46 of the subjects began using aspirin, or in one case a similar drug called clopidogrel, during follow-up. Reasons for using these drugs included heart disease and stroke-related problems.

Thirty-nine patients had another ICH. However, treatment with aspirin or clopidogrel did not significantly increase the risk of repeat ICH, the findings indicate.

These results suggest that anticlotting therapy can be used in a selected group of ICH survivors without significantly increasing the risk of another ICH, Smith and colleagues write.

However, they caution that the doctors may have avoided anticlotting drug therapy in patients perceived to be at higher risk of recurrence, which could have resulted in an underestimate of risk.

In a related editorial, Dr. Larry B. Goldstein, from Duke University in Durham, North Carolina, points out that the study's small size limits the statistical capabilities of the researchers' analysis. He also echoes their concern, and concludes that until more data become available, anticlotting treatment for patients who have had an ICH should be limited to highly selected patients with a compelling reason for using these drugs and with a relatively low risk of recurrent bleeding.

SOURCE: Neurology, January 24, 2006.