Is the Benefit of Antithrombotics and Statins Worth the Risk of Intracerebral Hemorrhage?

Abstract

Antithrombotics (such as antiplatelets and anticoagulants) and statins are often prescribed for primary or secondary vascular prevention. From a clinical perspective, practitioners often weigh the risk of bleeding, which is traditionally associated with antithrombotics, against their potential benefit. Such benefit/risk considerations have been the driver of randomized clinical trials investigating the role of aspirin in primary or secondary vascular prevention among specific populations at risk.1– 3 Intracerebral hemorrhage (ICH) is perhaps one of the most feared side effects of antithrombotic use because of its high risk of mortality and morbidity.4 Although the initial publication of results from the SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) trial5 suggested that the risk of ICH associated with statins among patients with noncardioembolic stroke was a concern, subsequent analyses from the SPARCL trial6 and other populationbased and hospital studies7– 9 reassuringly showed that statins do not increase the risk of ICH.