WSC 2026 | Antithrombotic therapy after ICH: insights from ASPIRING and ENRICH-AF
Aristeidis Katsanos, MD, PhD, McMaster University, Hamilton, Canada, shares the evidence on starting or restarting antithrombotic therapy in patients who have had an intracerebral hemorrhage (ICH). He notes that the ASPIRING study (ISRCTN16705062) is ongoing to assess the effectiveness of aspirin in secondary prevention, and shares insights from the ENRICH-AF trial (NCT03950076). This interview took place at the 18th World Stroke Congress (WSC) in Seoul, Korea.
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Transcript
There is a lot of uncertainty about starting or restarting antibiotics. For aspirin, we have good evidence from the research trial that restarting or starting aspirin, if there is an indication for it after an ICH, seems to be safe. We don’t know exactly how effective that is. There is an ongoing trial called ASPIRING. Hopefully, it’s going to answer that question. When it comes to blood thinners, so for example, if you have atrial fibrillation and you have a recent intracranial hemorrhage, evidence we have today tells us that, you know, we’re not sure about the net clinical benefits...
There is a lot of uncertainty about starting or restarting antibiotics. For aspirin, we have good evidence from the research trial that restarting or starting aspirin, if there is an indication for it after an ICH, seems to be safe. We don’t know exactly how effective that is. There is an ongoing trial called ASPIRING. Hopefully, it’s going to answer that question. When it comes to blood thinners, so for example, if you have atrial fibrillation and you have a recent intracranial hemorrhage, evidence we have today tells us that, you know, we’re not sure about the net clinical benefits. So, my colleague, Ashkan Shoamanesh, finished the ENRICH-AF study. So, what we did see is that, you know, starting or restarting a blood thinner in a patient that has atrial fibrillation and a recent intracranial hemorrhage, you reduce the risk of ischemic stroke, but you also increase the risk of hemorrhagic stroke. So the net benefit is actually neutral in this regard.
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