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Aspirin therapy may be safe for some
survivors of brain hemorrhage
Study finds no increased risk for
second hemorrhage, careful patient selection advised
BOSTON - January 23, 2006 - A study from the Stroke
Service at Massachusetts General Hospital (MGH) has found that
some patients who have survived an intracerebral hemorrhage - a
stroke caused by bleeding in the brain - may be safely treated with
aspirin to prevent future heart attacks or strokes caused by blood
clots. The study, appearing in the January 24 issue of the journal
Neurology, addresses a fairly common clinical dilemma.
"The two types of stroke - ischemic, caused by a clot cutting
off the brain's blood supply, and hemorrhagic, caused by bleeding
in the brain - share many of the same risk factors," says Eric
Smith, MD, MPH, of MGH Neurology, the study's senior author. "Physicians
often see patients with a history of intracerebral hemorrhage who
are also at risk for ischemic stroke or heart attacks and need to
decide what kind of preventive treatment to recommend. We have not
yet had a good answer to whether daily aspirin therapy would be
safe for these patients or would increase the risk of another hemorrhage."
The researchers followed a group of 207 patients who had survived
intracerebral hemorrhage during the period from 1994 to 2004. The
patients were surveyed by telephone every six months and asked about
any recurrence of hemorrhage or other neurologic disorders and whether
they took aspirin or other antiplatelet therapies. While 18 percent
of the study participants had recurrent hemorrhages during an average
of 20 months of follow-up, the risk was no greater among the 46
patients who reported taking antiplatelet therapy than it was among
the 161 who did not take aspirin. The only factor associated with
increased risk of recurrence was the location of the original hemorrhage,
with greater risk associated with hemorrhage in the cerebral cortex
than in the deep structure of the brain, which had been observed
in previous studies.
"While it would be premature to conclude that all patients
with intracerebral hemorrhage can safely take aspirin, our results
suggest it may be appropriate for some patients at elevated risk
of ischemic stroke or heart disease," says Smith. "The
most definitive information would come from a clinical trial in
which patients were randomly assigned to receive aspirin or a placebo.
But I think such a trial is unlikely, so this may be the best data
that will be available." He is an instructor in Neurology at
Harvard Medical School.
The study's coauthors are first author Anand Viswanathan, MD, PhD;
Susan Rakich; Chana Engel; Ryan Snider; Jonathan Rosand, MD, MSc;
and Steven Greenberg, MD, PhD - all of the MGH Department of Neurology.
The study was supported by funding from the National Institute of
Neurological Disorders and Stroke.
Massachusetts General Hospital, established in 1811, is the original
and largest teaching hospital of Harvard Medical School. The MGH
conducts the largest hospital-based research program in the United
States, with an annual research budget of nearly $500 million and
major research centers in AIDS, cardiovascular research, cancer,
cutaneous biology, medical imaging, neurodegenerative disorders,
transplantation biology and photomedicine. In 1994, MGH and Brigham
and Women's Hospital joined to form Partners HealthCare System,
an integrated health care delivery system comprising the two academic
medical centers, specialty and community hospitals, a network of
physician groups, and nonacute and home health services.
Media Contact: Sue
McGreevey, MGH Public Affairs
Physician Referral Service: 1-800-388-4644
Information about Clinical Trials
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