A new analysis of hospital registry data presented at the American Stroke Association’s International Stroke Conference 2026 suggests that people who were taking multiple antiplatelet medications or stronger agents before experiencing a brain bleed (intracranial hemorrhage) were more likely to die in the hospital compared to those not on any antiplatelet therapy. The study, which examined more than 400,000 adults hospitalized with a brain bleed between 2011 and 2021, found that patients on aspirin alone did not have an elevated risk of death, whereas those on potent antiplatelets—either alone or combined with aspirin—faced worse outcomes.
Antiplatelet medications, such as aspirin, clopidogrel, prasugrel, and ticagrelor, are commonly prescribed to prevent blood clots that cause heart attacks and ischemic strokes. However, their use also carries a risk of bleeding, including into the brain. According to the American Heart Association’s 2026 Heart Disease and Stroke Statistics, intracranial hemorrhage accounts for about 10% of all strokes in the U.S.
Lead study author Santosh Murthy, M.D., M.P.H., an associate professor of neurology and neuroscience at Weill Cornell Medicine in New York City, noted that prior research grouped all antiplatelet therapies 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,” he said.
The study analyzed data from the American Heart Association’s Get With The Guidelines-Stroke Registry, which includes patients from hundreds of U.S. hospitals. Among 426,481 adults hospitalized with intracranial hemorrhage (average age 67; 53% men), 109,512 were taking only one antiplatelet, 17,009 were on two antiplatelets, and 300,558 had no antiplatelet therapy before the bleed. Patients on anticoagulants were excluded.
After adjusting for demographic factors, vascular conditions, stroke severity, and hospital characteristics, the researchers found that compared to those on no antiplatelet therapy: patients taking aspirin alone had no increased risk of in-hospital death and even showed lower odds of an unfavorable outcome (death or discharge to hospice); patients taking a stronger antiplatelet medication, either alone or in combination with aspirin, had a significantly increased risk of death in the hospital; and there was a trend toward a higher risk of an unfavorable outcome with potent or dual antiplatelet therapy.
Dr. Jonathan Rosand, M.D., M.Sc., FAHA, an American Stroke Association volunteer expert and professor of neurology at Harvard, commented on the findings: “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. This new study shows that if a stroke occurs while on these treatments, it is more likely to be fatal.” Rosand, who was not involved in the study, added that patients should consult their health care professional to ensure the benefits of these medications outweigh the risks.
The study did not analyze the risk of having a brain bleed from different antiplatelet medications, only outcomes after such a bleed occurred. Current guidelines do not recommend platelet transfusions for bleeding in the brain unless immediate surgery is needed. The researchers suggest future studies should examine whether platelet transfusions could improve outcomes for patients on single versus dual antiplatelet therapy.
Limitations include the lack of data on specific characteristics of the brain bleed, such as volume or location, which could influence severity. The findings are considered preliminary until published in a peer-reviewed journal. The abstract was presented at the American Stroke Association’s International Stroke Conference 2026 in New Orleans, Feb. 4-6.
