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Aspirin 'safe' For Brain-bleed Strokes
By Michelle RobertsHealth editor, BBC News online
Patients who have had a stroke caused by bleeding in the brain can safely take aspirin to cut their risk of future strokes and heart problems, according to a new study.
Aspirin thins the blood and so doctors have been cautious about giving it, fearing it could make bleeds worse.
But The Lancet research suggests it does not increase the risk of new brain bleeds, and may even lower it.
Experts say the "strong indication" needs confirming with more research.
Only take daily aspirin if your doctor recommends it, they advise.
Aspirin benefits and risksAspirin is best known as a painkiller and is sometimes also taken to help bring down a fever.
But daily low-dose (75mg) aspirin is used to make the blood less sticky and can help to prevent heart attacks and stroke.
Most strokes are caused by clots in the blood vessels of the brain but some are caused by bleeds.
Because aspirin thins the blood, it can sometimes make the patient bleed more easily.
And aspirin isn't safe for everyone.
It can also cause indigestion and, more rarely, lead to stomach ulcers.
Never give aspirin to children under the age of 16 (unless their doctor prescribes it).
It can make children more likely to develop a very rare but serious illness called Reye's syndrome (which can cause liver and brain damage).
The studyThe research involved 537 people from across the UK who had had a brain bleed while taking anti-platelet medicines, to stop blood clotting, including aspirin, dipyridamole or another drug called clopidogrel.
The work is being presented at the European Stroke Organisation Conference in Milan.
What do experts say?The research cannot prove that aspirin prevents future strokes but it appears to be linked to a lower risk.
Nor does it suggest that aspirin is always safe to take.
But it hints that more patients - those with haemorrhagic or brain bleed strokes - might benefit from daily treatment.
It's not clear if the study findings will apply to all patients in real life.
Lead researcher, Prof Rutsam Salman, from the University of Edinburgh, said: "At the moment, people do not know what the right thing to do is.
"Doctors are hesitant about giving aspirin or aspirin-like drugs to people who have had this type of stroke.
"UK and European guidelines do not give any recommendation, because there hasn't been enough evidence.
"I think we have now confirmed safety with these findings.
"It certainly seems that aspirin is safe enough to give."
Prof Salman recommended more work to see if aspirin might actually lower the risk of brain bleeds as well as clots.
Prof Metin Avkiran, from the British Heart Foundation, which funded the research, said: "Around a third of people who suffer a brain haemorrhage, also known as haemorrhagic stroke, do so when they are taking an anti-platelet medicine, such as aspirin, to reduce the risk of a heart attack or an ischaemic [blood clot] stroke.
"We now have a strong indication they can carry on taking these potentially life-saving medicines after the brain haemorrhage without increasing the risk of another one, which is crucial new information for both patients and doctors."
Anyone with concerns should speak to a doctor before considering changing medication, however.
Preventing a strokeYou can reduce your risk by:
Improving Outcomes For Patients With A Deadly Form Of Brain Bleed
A new study reveals that drainage of cerebrospinal fluid through the spine could help improve outcomes for patients with aneurysmal subarachnoid hemorrhage (aSAH).
The study, led by researchers from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King's College London and King's College Hospital NHS Foundation Trust, reveals the positive effect of drainage of cerebrospinal fluid—fluid that fills the ventricles of the brain and surrounds the brain and spinal cord—in the aftermath of a brain bleed.
The results indicate that this treatment can reduce the chances of stroke and artery narrowing, which can cause oxygen deprivation in the brain. This can ultimately reduce the likelihood of death without raising the risk of complications such as infection and protracted length of hospital stay. These findings are published in World Neurosurgery.
Research on this topic has been focusing on finding new treatments for delayed insufficient blood supply to the brain following aSAH, a deadly form of brain bleeding. It is believed that the amount of bleed and deposition of its metabolic blood products, which are irritants around the brain, confer the risks of delayed blood flow to the brain and artery narrowing, swelling and subsequent death of brain tissues.
Drainage of cerebrospinal fluid, which can counter this platelet activity, may help clear away these irritants, thereby limiting the narrowing of blood vessels in the brain. Until now, studies on this have been inconclusive.
"Our research shows that drainage of cerebrospinal fluid—fluid that fills the ventricles of the brain and surrounds the brain and spinal cord—through the lumbar spine, can improve outcomes for patients with aneurysmal subarachnoid hemorrhage, a deadly form of brain bleed. This form of drainage improves blood flow to the brain and enhances the chances of survival without an increased risk of complications, and is potentially a treatment modality for aSAH, which has few effective treatments.
"While further gold-standard randomized controlled studies are needed to validate our preliminary findings, the study provides useful insights that may help in designing future research," says Dr. Keng Siang Lee, honorary lecturer at King's IoPPN.
More information: Keng Siang Lee et al, Effectiveness of Cerebrospinal Fluid Lumbar Drainage Among Patients with Aneurysmal Subarachnoid Hemorrhage: An Updated Systematic Review and Meta-Analysis, World Neurosurgery (2024). DOI: 10.1016/j.Wneu.2024.01.062
Citation: Improving outcomes for patients with a deadly form of brain bleed (2024, February 1) retrieved 29 February 2024 from https://medicalxpress.Com/news/2024-02-outcomes-patients-deadly-brain.Html
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Brain Arteriovenous Malformations (AVMs)
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The goal of AVM treatment is to prevent bleeding from the AVM. When an AVM bleeds, it can damage the surrounding brain tissue with mild to serious consequences (Figure 2). Some of the problems encountered after AVM rupture can include body weakness, loss of speech, numbness, paralysis, coma and even death.
The risk of AVM bleeding depends on several factors, including AVM location, history of prior AVM bleeding, and the presence of any dangerous features, such as aneurysms or blisters on the AVM vessels. The risk of bleeding for unruptured AVMs is two percent per year. If the AVM has ruptured or has one or more dangerous characteristics, the rate is often higher. Despite the low two percent annual bleed risk, the chances of an AVM bleeding at some point during a person's lifetime adds up. Therefore, young people who are diagnosed with an AVM have a higher risk of a brain bleed at some point in their lifetime and treatment is often recommended.
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