Aspirin Safe for Post-Stoke Patients: The RESTART Trial

Aspirin can be taken after a stroke without raising the risk for a subsequent stroke, results from a new trial indicated.

“Around a third of people who suffer a brain hemorrhage, also known as hemorrhagic stroke, do so when they are taking an antiplatelet medicine such as aspirin to reduce the risk of a heart attack or an ischemia stroke” said Professor Metin Avkiran, Associate Medical Director at the British Heart Foundation (BHF), in a press release about the trial. “We now have a strong indication they can carry on taking these potentially life-saving medicines after the brain hemorrhage without increasing the risk of another one, which is crucial new information for both patients and doctors.

Rest Assured

The results of the Restart or Stop Antithrombotics Randomised Trial (RESTART) trial, a prospective, randomized, open-label, blinded endpoint parallel-group study across 122 centers, were published in The Lancet. The study included 537 participants taking antithrombotic (antiplatelet or anticoagulant) who developed an intracerebral hemorrhage, discontinued therapy, and survived for a period of 24 hours. They randomized patients (1:1) to either start (n=268) or avoid therapy (n=269), and followed participants out to 5 years for the primary outcome of recurrent symptomatic intracerebral hemorrhage.

According to the results, 12 participants in the therapy group had recurrent intracerebral hemorrhage compared with 23 in the avoidance group (adjusted HR=0.51; 95% CI, 0.25 to 1.03; P=0.060). Eighteen participants in the therapy group experienced major hemorrhagic events compared with 25 in the avoidance cohort, a difference which did not reach statistical significance. Additional, 39 patients in the therapy group had major occlusive vascular events compared with 38 in the avoidance cohort (also not statistically significant).

“The results of the RESTART trial are reassuring for survivors of brain hemorrhage who need to take antiplatelet medicines to prevent heart attacks and strokes,” Professor Rustam Salman, of the University of Edinburgh’s Centre for Clinical Brain Sciences, said in the press release. “I am keen to investigate the possibility that these medicines might halve the risk of brain hemorrhage happening again.”

RESTART @RUSH @edinburghstroke findings will impact on my clinical practice from now. Safe to restart antiplatelet after primary ICH. Example of a well-designed RCT giving gold-standard scientific evidence, breaking a common myth based on observational data #esoc2019 https://t.co/gHoqzGGp5H

— Yvonne Chun PhD (@DrYvonneChun) May 22, 2019

https://twitter.com/ProfGerMed/status/1131180438871875584

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial https://t.co/Lu0ge098sW

— PMS Instruments (@pmsinstruments) May 22, 2019

Full paper in @TheLancet https://t.co/oXpXGmfIbN

— Peter Willeit (@PeterWilleit) May 22, 2019