{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:38:55Z","timestamp":1787027935638,"version":"build-2736575974"},"reference-count":42,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Intracerebral hemorrhage management presents clinicians with a significant therapeutic challenge. Maintaining antiplatelet therapy potentially increases the risk of recurrent bleeding, while discontinuation heightens susceptibility to ischemic stroke, particularly during the critical first month after hemorrhage. In contemporary practice, physicians demonstrate considerable hesitancy regarding early antiplatelet reinitiation, complicated by the absence of clear evidence-based treatment guidelines. Aim: This meta-analysis assesses the safety of early antiplatelet resumption following ICH. Methods: We conducted a systematic review by searching Web of Science, Scopus, PubMed, and Cochrane Library from inception to April 2025. Articles were independently screened and data extracted by two reviewers who also assessed study quality. The inclusion criteria are enrollment of adults (\u226518 years) with imaging-confirmed intracerebral hemorrhage surviving &gt;24 h, comparing early vs. delayed or withheld antiplatelet therapy. Randomized trials underwent separate evaluation using Cochrane\u2019s Risk of Bias. Statistical analysis was performed using R software (version 4.4.2), with categorical outcomes pooled as risk ratios (RRs) with 95% confidence intervals. Statistical significance was established at p &lt; 0.05. The evidence is limited by the availability of few RCTs, variable antiplatelet regiments, male predominance, and other confounding factors. The review was registered in SFO. Results: Our meta-analysis included 10 studies (8 observational, 2 RCTs) with 5554 patients. Early antiplatelet therapy significantly reduced recurrent intracerebral hemorrhage by 46% (RR 0.54, 95% CI 0.37\u20130.78, p = 0.001). All-cause mortality showed a non-significant difference (RR 0.81, 95% CI 0.65\u20131.01, p = 0.06). No significant differences were found for ischemic stroke (RR 0.99, 95% CI 0.60\u20131.63, p = 0.96), major hemorrhagic events (RR 0.75, 95% CI 0.49\u20131.13, p = 0.17), or ischemic vascular outcomes (RR 0.71, 95% CI 0.49\u20131.02, p = 0.60). Conclusions: Our meta-analysis reveals that early antiplatelet therapy following intracerebral hemorrhage significantly reduces recurrent hemorrhagic events (46% reduction) without increasing major ischemic or hemorrhagic complications.<\/jats:p>","DOI":"10.3390\/diagnostics15141780","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T08:04:41Z","timestamp":1752566681000},"page":"1780","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Antiplatelet Resumption After Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"given":"Sarah Yahya","family":"Alharthi","sequence":"first","affiliation":[{"name":"College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1683-0522","authenticated-orcid":false,"given":"Sarah Abdulaziz","family":"Alsheikh","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7458-1508","authenticated-orcid":false,"given":"Dawood Salman","family":"Almousa","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saud Samer A.","family":"Alsedrah","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9161-2119","authenticated-orcid":false,"given":"Nouf Mohammed","family":"Alshammari","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariam Mostafa","family":"Elsayed","sequence":"additional","affiliation":[{"name":"College of Medicine, AlMaarefa University, P.O. Box 71666, Riyadh 11597, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahaf Ali Hamed","family":"AlShamrani","sequence":"additional","affiliation":[{"name":"College of Medicine, AlMaarefa University, P.O. Box 71666, Riyadh 11597, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Ahmed Yaslam","family":"Bellahwal","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0764-463X","authenticated-orcid":false,"given":"Abdulrahman","family":"Alnwiji","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1587-3675","authenticated-orcid":false,"given":"Raed A.","family":"Albar","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4827-855X","authenticated-orcid":false,"given":"Ayman M. A.","family":"Mohamed","sequence":"additional","affiliation":[{"name":"College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1212\/01.wnl.0000179178.37713.69","article-title":"Antiplatelet therapy contributes to acute deterioration of intracerebral hemorrhage","volume":"65","author":"Toyoda","year":"2005","journal-title":"Neurology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1007\/s12028-015-0222-x","article-title":"Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage: A Statement for Healthcare Professionals from the Neurocritical Care Society and Society of Critical Care Medicine","volume":"24","author":"Frontera","year":"2016","journal-title":"Neurocrit. Care"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.1007\/s00415-007-0559-y","article-title":"Clustering of vascular risk factors and in-hospital death after acute ischemic stroke","volume":"254","author":"Roquer","year":"2007","journal-title":"J. Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1016\/j.jacc.2019.10.066","article-title":"Management of Intracerebral Hemorrhage","volume":"75","author":"Schrag","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1161\/01.STR.31.1.123","article-title":"Rate of Stroke Recurrence in Patients With Primary Intracerebral Hemorrhage","volume":"31","author":"Hill","year":"2000","journal-title":"Stroke"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3567","DOI":"10.1161\/STROKEAHA.109.556324","article-title":"Three-Year Survival and Stroke Recurrence Rates in Patients With Primary Intracerebral Hemorrhage","volume":"40","author":"Zia","year":"2009","journal-title":"Stroke"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1161\/CIRCULATIONAHA.115.015735","article-title":"Restarting Anticoagulant Treatment After Intracranial Hemorrhage in Patients with Atrial Fibrillation and the Impact on Recurrent Stroke, Mortality, and Bleeding: A Nationwide Cohort Study","volume":"132","author":"Nielsen","year":"2015","journal-title":"Circulation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1177\/19418744211026709","article-title":"Risk of Mortality After an Arterial Ischemic Event Among Intracerebral Hemorrhage Survivors","volume":"12","author":"Parasram","year":"2022","journal-title":"Neurohospitalist"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1212\/01.wnl.0000194267.09060.77","article-title":"Antiplatelet use after intracerebral hemorrhage","volume":"66","author":"Viswanathan","year":"2006","journal-title":"Neurology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2613","DOI":"10.1016\/S0140-6736(19)30840-2","article-title":"Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): A randomised, open-label trial","volume":"393","author":"Salman","year":"2019","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1001\/jamaneurol.2021.2956","article-title":"Effects of Antiplatelet Therapy After Stroke Caused by Intracerebral Hemorrhage: Extended Follow-up of the RESTART Randomized Clinical Trial","volume":"78","author":"Salman","year":"2021","journal-title":"JAMA Neurol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1161\/STROKEAHA.119.026207","article-title":"Risk of Arterial Ischemic Events After Intracerebral Hemorrhage","volume":"51","author":"Murthy","year":"2020","journal-title":"Stroke"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1159\/000514552","article-title":"Antiplatelet Therapy after Intracerebral Hemorrhage and Subsequent Clinical Events: A 12-Year South Korean Cohort Study","volume":"84","author":"Moon","year":"2021","journal-title":"Eur. Neurol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1136\/jnnp-2013-306476","article-title":"Long-term prognosis after intracerebral haemorrhage: Systematic review and meta-analysis","volume":"85","author":"Poon","year":"2014","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_15","first-page":"CD012144","article-title":"Antithrombotic treatment after stroke due to intracerebral haemorrhage","volume":"5","author":"Perry","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2700","DOI":"10.1136\/bmj.b2700","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration","volume":"339","author":"Liberati","year":"2009","journal-title":"BMJ"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., and Welch, V.A. (2019). Cochrane Handbook for Systematic Reviews of Interventions, John Wiley & Sons. [2nd ed.].","DOI":"10.1002\/9781119536604"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses","volume":"25","author":"Stang","year":"2010","journal-title":"Eur. J. Epidemiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1212\/WNL.0000000000005742","article-title":"Restarting antiplatelet therapy after spontaneous intracerebral hemorrhage: Functional outcomes","volume":"91","author":"Chen","year":"2018","journal-title":"Neurology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1160\/TH11-06-0439","article-title":"Use of aspirin in Chinese after recovery from primary intracranial haemorrhage","volume":"107","author":"Chong","year":"2012","journal-title":"Thromb. Haemost."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2606","DOI":"10.1161\/STROKEAHA.110.589143","article-title":"Prescribing Antiplatelet Medicine and Subsequent Events After Intracerebral Hemorrhage","volume":"41","author":"Flynn","year":"2010","journal-title":"Stroke"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2396","DOI":"10.1160\/TH17-05-0342","article-title":"Low-Dose Aspirin after an Episode of Haemorrhagic Stroke Is Associated with Improved Survival","volume":"117","author":"Gaist","year":"2017","journal-title":"Thromb. Haemost."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"107361","DOI":"10.1016\/j.clineuro.2022.107361","article-title":"Clinical effects of restarting antiplatelet therapy in patients with intracerebral hemorrhage","volume":"220","author":"Jung","year":"2022","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1161\/STROKEAHA.122.040500","article-title":"Early Antiplatelet Resumption and the Risks of Major Bleeding After Intracerebral Hemorrhage","volume":"54","author":"Liu","year":"2023","journal-title":"Stroke"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1016\/S1474-4422(24)00424-1","article-title":"Safety and efficacy of early versus delayed acetylsalicylic acid after surgery for spontaneous intracerebral haemorrhage in China (E-start): A prospective, multicentre, open-label, blinded-endpoint, randomised trial","volume":"23","author":"Liu","year":"2024","journal-title":"Lancet Neurol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2923","DOI":"10.1007\/s10143-021-01483-8","article-title":"Low-dose antiplatelet therapy survey after intracerebral hemorrhage in China: A retrospective hospital-based study","volume":"44","author":"Ma","year":"2021","journal-title":"Neurosurg. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3151","DOI":"10.1161\/STROKEAHA.114.005787","article-title":"Aspirin should be discontinued after lobar intracerebral hemorrhage","volume":"45","author":"Falcone","year":"2014","journal-title":"Stroke"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1212\/WNL.0000000000004259","article-title":"Brain hemorrhage recurrence, small vessel disease type, and cerebral microbleeds: A meta-analysis","volume":"89","author":"Charidimou","year":"2017","journal-title":"Neurology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1212\/WNL.0b013e3181eee40f","article-title":"Aspirin and recurrent intracerebral hemorrhage in cerebral amyloid angiopathy","volume":"75","author":"Biffi","year":"2010","journal-title":"Neurology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.wneu.2017.06.015","article-title":"Antiplatelet Resumption after Antiplatelet-Related Intracerebral Hemorrhage: A Retrospective Hospital-Based Study","volume":"106","author":"Teo","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1161\/STROKEAHA.122.036884","article-title":"Cardiovascular Events After Intracerebral Hemorrhage","volume":"53","author":"Li","year":"2022","journal-title":"Stroke"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.1056\/NEJMoa1401105","article-title":"Aspirin in patients undergoing noncardiac surgery","volume":"370","author":"Devereaux","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.jns.2017.11.009","article-title":"Resumption of antiplatelet therapy in patients with primary intracranial hemorrhage-benefits and risks: A meta-analysis of cohort studies","volume":"384","author":"Ding","year":"2018","journal-title":"J. Neurol. Sci."},{"key":"ref_35","first-page":"CD012144","article-title":"Antithrombotic treatment after stroke due to intracerebral haemorrhage","volume":"1","author":"Cochrane","year":"2023","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1159\/000065661","article-title":"Antithrombotic Therapy in Patients with Any Form of Intracranial Haemorrhage: A Systematic Review of the Available Controlled Studies","volume":"14","author":"Keir","year":"2002","journal-title":"Cerebrovasc. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3149","DOI":"10.1161\/STROKEAHA.114.005786","article-title":"Antiplatelet therapy may be continued after intracerebral hemorrhage","volume":"45","author":"Dennis","year":"2014","journal-title":"Stroke"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1136\/svn-2020-000433","article-title":"Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: Executive summary and 2019 update of clinical management of intracerebral haemorrhage","volume":"5","author":"Cao","year":"2020","journal-title":"Stroke Vasc. Neurol."},{"key":"ref_39","unstructured":"Intercollegiate Stroke Working Party in collaboration with the Scottish Intercollegiate Guidelines Network (SIGN) and the National Clinical Programme for Stroke Ireland (2023). National Clinical Guideline for Stroke for the United Kingdom and Ireland, Intercollegiate Stroke Working Party."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"E282","DOI":"10.1161\/STR.0000000000000407","article-title":"2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association\/American Stroke Association","volume":"53","author":"Greenberg","year":"2022","journal-title":"Stroke"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1177\/1747493020968424","article-title":"Canadian stroke best practice recommendations: Management of Spontaneous Intracerebral Hemorrhage, 7th Edition Update 2020","volume":"16","author":"Shoamanesh","year":"2021","journal-title":"Int. J. Stroke"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/14\/1780\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:09:45Z","timestamp":1760033385000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/14\/1780"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,15]]},"references-count":42,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["diagnostics15141780"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15141780","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,15]]}}}