Risk of bleeding in stroke patients on antiplatelet therapy

This study examined the risk of bleeding due to dual antiplatelet therapy in stroke patients. The authors concluded that patients treated with dual antiplatelet therapy have a higher risk of major and gastrointestinal bleeding within the first 30 days of treatment.

Antiplatelet therapies (such as aspirin) are used to prevent blood clots, heart attacks and stroke, as they reduce blood clotting. These are commonly given to stroke patients to prevent further cardiovascular disease and stroke. The side effects, however, include a higher risk of bleeding. It is unknown whether the risk of bleeding differs over time on duel therapy, when patients are treated with more than one antiplatelet drug.

This meta-analysis looked at the risk of bleeding in stroke patients treated with single or dual antiplatelet therapy over time.

The study included 6 trials with a combined 45,195 patients. There were a total of 1,338 major bleeds and 618 gastrointestinal bleeds. The risks of major bleeding and gastrointestinal bleeding were highest during the first 30 days of treatment on dual therapy. The risk was 5.8% for patients treated with aspirin and clopidogrel (Plavix) and 4.9% for patients treated with aspirin and dipyridamole (Persantine). The risk of bleeding from dual therapy was reduced by 98% after the first 31 days of treatment.

The risk of bleeding on single therapy was 2.8% on aspirin and 2.5% on clopidogrel alone. There was no increased of bleeding for patients treated with dipyridamole alone. The risk did not change over time on single therapy.

The authors concluded that dual antiplatelet therapy is associated with a high early risk of major and gastrointestinal bleeding that declines after 1 month.