Towards individualised secondary prevention after intracerebral haemorrhage

Stroke is a leading cause of death and disability-adjusted life-years lost worldwide, partly owing to its high risk of recurrence as well as major vascular events. 1 Poon MT Fonville AF Al-Shahi Salman R Long-term prognosis after intracerebral haemorrhage: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2014; 85: 660-667 Crossref PubMed Scopus (284) Google Scholar After ischaemic stroke or transient ischaemic attack, antiplatelet therapy prevents major vascular events, although patients with intracerebral haemorrhage (ICH) were not included in the randomised trials that showed this. 2 Baigent C Blackwell L et al. Antithrombotic Trialists' (ATT) CollaborationAspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009; 373: 1849-1860 Summary Full Text Full Text PDF PubMed Scopus (2584) Google Scholar More than 40% of recurrent strokes after ICH are ischaemic, 3 Chen Y Wright N Guo Y et al. Mortality and recurrent vascular events after first incident stroke: a 9-year community-based study of 0·5 million Chinese adults. Lancet Glob Health. 2020; 8: e580-e590 Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar but the risks of all major vascular events are less well known. This uncertainty leaves clinicians with dilemmas about the long-term use of antithrombotic therapy for the secondary prevention of major vascular events after ICH, as clinicians need to weigh the effects of antiplatelet therapy on ischaemic vascular events against the unknown effects on haemorrhagic events. Risks of recurrent stroke and all serious vascular events after spontaneous intracerebral haemorrhage: pooled analyses of two population-based studiesThe risks of recurrent ICH, ischaemic stroke, and all serious vascular events after ICH differ by ICH location and comorbid AF. These data enable risk stratification of patients in clinical practice and ongoing randomised trials. Full-Text PDF Open Access