July 19, 2019
Antiplatelet therapy presents only a very modest risk for recurrent intracerebral hemorrhage in the presence of cerebral microbleeds, according to subgroup analyses of the RESTART trial.
RESTART was a prospective, randomized, open-label, blinded-endpoint, parallel-group trial held across 122 UK hospitals and showed that beginning antiplatelet therapy—compared with avoiding the therapy—may reduce the risk for recurrent symptomatic intracerebral hemorrhage.
To assess whether intracerebral hemorrhage and cerebral small vessel diseases alter the effects of antiplatelet therapy that the RESTART trial found, the researchers analyzed data from 537 participants who were enrolled between May 22, 2013, and May 31, 2018.
In all, 525 participants had intracerebral hemorrhage. Of the 507 participants who had been diagnosed via computed tomography, 252 began antiplatelet therapy and 255 did not. Of the 254 participants who underwent the required brain magnetic resonance imaging (MRI) protocol, 122 participants began antiplatelet therapy and 132 did not.
“We did not find clinically or statistically significant hazardous effects of antiplatelet therapy on recurrent intracerebral hemorrhage in any primary subgroup analyses of cerebral microbleed presence (2 or more) versus absence (0 or 1),” the study authors wrote.
Further, antiplatelet therapy did not pose a hazard for recurrent intracerebral hemorrhage in primary subgroup analyses of cerebral microbleed number 0 or 1 vs 2 to 4 vs 5 or more as well as cerebral microbleed strictly lobar vs other location.
“There was no evidence of heterogeneity in the effects of antiplatelet therapy in any exploratory subgroup analyses,” the researchers concluded.
Al-Shahi Salman R, Minks DP, Mitra D, et al; RESTART Collaboration. Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial. Lancet Neurol. 2019;18(7):643-652. https://doi.org/10.1016/S1474-4422(19)30184-X.