Should patients restart antiplatelet drugs after a haemorrhagic stroke?

REstart or STop Antiplatelets Randomised Trial (RESTART)

More than one third of the adults with a stroke due to bleeding into the brain – known as brain haemorrhage – are taking drugs to prevent clotting when they have a brain haemorrhage. These patients have previously suffered illnesses like angina, heart attack, or stroke due to blood vessel blockage, which is why they are treated with drugs to prevent further clots occurring. These drugs are usually stopped when the brain haemorrhage occurs. But when patients recover from brain haemorrhage, they and their doctors are often uncertain about whether to restart these drugs to prevent further clots occurring, or whether to avoid them in case they increase the risk of brain haemorrhage happening again. In this preliminary study of 720 such people who survive a brain haemorrhage, Dr Rustam Al-Shahi Salman and his team will study the potential beneficial effects of three antiplatelet drugs (one or more of aspirin, clopidogrel, or dipyridamole, chosen by the patient’s physician) on the risks of heart attack, stroke and other clotting problems as well as their effect on the risk of a brain haemorrhage happening again. This information will help doctors decide whether antiplatelet drugs are a promising treatment. If they are, the investigators plan to recruit a much larger number of patients so that they can determine really reliably whether the beneficial effects of antiplatelet drugs on the risk of clotting outweigh any risks of a repeat brain haemorrhage for such people.