P2Y12 Inhibitors Linked to Worse Outcomes After Spontaneous Intracerebral Hemorrhage: JAMA
USA: A registry-based cohort study, published in JAMA Network Open, has found that prior use of P2Y12 inhibitors (alone or combined with aspirin) was relatively common among patients with spontaneous intracerebral hemorrhage (ICH) not related to anticoagulants.
Compared with aspirin alone or no antiplatelet therapy, P2Y12 inhibitor use was associated with more severe strokes, higher in-hospital mortality, poorer clinical outcomes, and reduced functional recovery. These findings suggest that pre-ICH use of P2Y12 inhibitors may be linked to a worse prognosis following spontaneous ICH.
P2Y12 inhibitors are widely prescribed to prevent cardiovascular events in patients with atherosclerotic disease, but limited evidence exists regarding their impact on outcomes after spontaneous intracerebral hemorrhage. To address this knowledge gap, researchers led by Chen Jin from the Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, evaluated the association between prior antiplatelet therapy and stroke severity and hospital outcomes in patients with ICH.
The researchers analyzed data from the nationwide Get With The Guidelines–Stroke registry, including 252,691 adults hospitalized with spontaneous intracerebral hemorrhage between 2013 and 2021, excluding anticoagulant-related cases. Patients were grouped according to antiplatelet therapy used within seven days before admission: P2Y12 inhibitor monotherapy, dual antiplatelet therapy (P2Y12 inhibitor plus aspirin), aspirin alone, or no antiplatelet therapy.
The primary outcomes were stroke severity at presentation, assessed using the National Institutes of Health Stroke Scale (NIHSS), and in-hospital mortality. Secondary outcomes included discharge home, independent ambulation, and functional independence at discharge.
Key findings of the study include:
- Prior use of P2Y12 inhibitors, either alone or with aspirin, was associated with a higher likelihood of severe stroke at presentation compared with aspirin alone.
- Patients receiving P2Y12 inhibitors had significantly higher in-hospital mortality than those treated with aspirin alone.
- Functional outcomes were poorer among patients with prior P2Y12 inhibitor use, with lower rates of discharge home, independent ambulation, and functional independence at discharge.
- In contrast, outcomes were similar between patients receiving aspirin alone and those with no prior antiplatelet therapy.
- Patients taking P2Y12 inhibitors were generally older and had a higher burden of cardiovascular risk factors than other groups.
The researchers noted that prior P2Y12 inhibitor use was associated with poorer outcomes after spontaneous ICH, although the observational design prevents establishing a causal relationship.
They acknowledged limitations, including the lack of detailed neuroimaging data, information on the timing of the last antiplatelet dose, limited use of newer P2Y12 inhibitors, absence of long-term follow-up, and restricted generalizability beyond participating stroke centers.
The authors concluded that prior P2Y12 inhibitor use, alone or with aspirin, was associated with more severe ICH, higher in-hospital mortality, and poorer functional recovery than aspirin alone or no antiplatelet therapy. They called for further research to identify optimal management strategies for P2Y12 inhibitor-associated ICH.
Reference:
Jin C, Song Y, Mac Grory B, et al. P2Y12 Inhibitors and Mortality in Patients Hospitalized With Intracerebral Hemorrhage. JAMA Netw Open. 2026;9(7):e2622239. doi:10.1001/jamanetworkopen.2026.22239
Next Story