BOSTON (MedPage Today) -- It may be acceptable in some circumstances to give aspirin or other platelet-aggregation inhibitors to survivors of cerebral hemorrhages, according to researchers here.

Common wisdom indicates that survivors of intracerebral hemorrhage, even though they are often at risk for ischemic strokes or heart attacks as well, should not be given aspirin or other antiplatelet therapy because of concerns about recurrent bleeding.

But in a review of data at Massachusetts General Hospital of patients who survived intracerebral hemorrhage, researchers found that among the 22% who later received antiplatelet agents to prevent ischemia, the therapy did not increased the risk of recurrent lobar or deep hemorrhage, Eric E. Smith, M.D., of Harvard and colleagues reported in the Jan. 24 issue of Neurology.

"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," said Dr. Smith and colleagues.

But in an accompanying editorial, Larry B. Goldstein M.D., of Duke in Durham, N.C., said that while the risk of antiplatelet therapy in these patients appears relatively small, so too does the benefit.

"Despite the lack of a demonstrable increased risk of recurrent intracranial bleeding in patients treated with platelet antiaggregants in this cohort, it is also uncertain whether the patients benefited from these drugs as their use was not associated with a significant reduction in ischemic cardiovascular events (four events in those taking platelet antiaggregants vs. seven in those not receiving these drugs; P=0.75)," Dr. Goldstein wrote.

The Boston researchers followed a group of 127 patients who had survived lobar intracerebral hemorrhages and 80 who had survived deep hemispheric hemorrhages from 1994 through 2004.

The survivors, all of whom were enrolled in a prospective cohort study, were followed by phone interview. The researchers recorded data on recurrent intracerebral hemorrhage and on the use and duration of antiplatelet agents following the original hemorrhage.

The analysis included creation of a Cox proportional hazard model, in which exposure to antiplatelet agents was recorded as a time-dependent variable in order to gauge the effect on risk of recurrent intracerebral hemorrhage.

Intracerebral hemorrhages recurred more frequently among survivors of lobar hemorrhage compared with those who survived deep hemisphere hemorrhage (cumulative two-year rate of 22% versus 4%, respectively, P = 0.007).

When it came to the use of antiplatelet therapies, however, there were no significant differences in hemorrhage recurrence. In all, 27 of 127 patients who had lobar hemorrhage and 19 of 80 who had deep hemispheric hemorrhage received antiplatelet therapy. The hazard ratio for recurrent intracerebral hemorrhage among survivors of lobar hemorrhage was 0.8 (95% confidence interval, 0.3 to 2.3, P= 0.73). For survivors of deep hemorrhage, the hazard ratio was 1.2 (95% CI, 0.1 to 14.3, P=0.88). "Our results have potential implications for the treatment of intracerebral hemorrhage survivors who are also at risk for ischemic cardiovascular diseases," Dr. Smith and colleagues wrote. "These data suggest that antiplatelet therapy may be used in selected intracerebral hemorrhage survivors without a substantial increase in the risk of recurrent intracerebral hemorrhage."

They noted, however, that their risk estimates were not based on evidence from a randomized trial and could be subject to confounding variables.

"It remains prudent for antiplatelet therapy to be considered only in selected intracerebral hemorrhage survivors at high risk for thrombotic diseases," they wrote. Dr. Goldstein agreed, writing that pending additional study data, the use of antiplatelet agents in this setting "should be restricted to highly selected patients with a compelling indication and with a relatively low risk of recurrent bleeding."