Does antiplatelet therapy at the time of intracerebral hemorrhage bode poor outcome

Warfarin users have higher case-fatality following intracerebral hemorrhage (ICH) compared to nonusers, as a result of larger hematoma volumes and longer periods of hematoma expansion.1,2 Antiplatelet therapy prolongs bleeding time and might be expected to produce similar effects on hematoma size and growth, but evidence for an independent effect of antiplatelet therapy on ICH outcomes has been inconsistent. While several studies demonstrated worse outcomes in patients taking antiplatelet agents, this can be attributed to the higher prevalence of previous stroke and cardiac disease in this group. The question of whether prior antiplatelet therapy predicts increased mortality and morbidity following ICH has important implications for treatment and research. Over 25% of patients with ICH take antiplatelet drugs at the time of stroke onset.3 A randomized controlled trial of platelet transfusion to prevent hematoma growth in patients with ICH taking antiplatelet therapy is already underway,4 and other trials that are not directly concerned with reversing the effect of antiplatelet therapy may need to consider stratifying randomization based on antiplatelet therapy use. In this …