Skip to content

Research at St Andrews

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Research output: Contribution to journalArticlepeer-review

Abstract

Background Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events.

Methods The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627).
Findings Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92).
Interpretation These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention.
Close

Details

Original languageEnglish
Pages (from-to)2613-2623
Number of pages11
JournalLancet
Volume393
Issue number10191
Early online date22 May 2019
DOIs
Publication statusPublished - 29 Jun 2019

Discover related content
Find related publications, people, projects and more using interactive charts.

View graph of relations

Related by author

  1. Over-use of thyroid testing in Canadian and UK primary care in frequent attenders: a cross-sectional study

    Crampton, N., Kalia, S., Del Giudice, M. E., Wintemute, K., Sullivan, F., Aliarzadeh, B., Meaney, C., Moineddin, R., Singer, A., Hinton, W., Sherlock, J., Williams, J., de Lusignan, S. & Greiver, M., 28 Mar 2021, In: International Journal of Clinical Practice. Early Vew, e14144.

    Research output: Contribution to journalArticlepeer-review

  2. Trends in diabetes medication use in Australia, Canada, England, and Scotland: A repeated cross-sectional analysis in primary care

    Greiver, M., Havard, A., Bowles, J. K. F., Kalia, S., Chen, T., Aliarzadeh, B., Moineddin, R., Sherlock, J., Hinton, W., Sullivan, F., O'Neill, B., Pow, C., Bhatt, A., Rahman, F., Meza-Torres, B., Litchfield, M. & de Lusignan, S., Mar 2021, In: British Journal of General Practice. 71, 704, p. E209-E218

    Research output: Contribution to journalArticlepeer-review

  3. Trends in diabetes medication use in Canada, England, Scotland and Australia: a repeated cross-sectional analysis (2012-2017)

    Greiver, M., Havard, A., Kuster Filipe Bowles, J., Kalia, S., Chen, T., Aliarzadeh, B., Moineddin, R., Sherlock, J., Hinton, W., Sullivan, F., O'Neill, B., Pow, C., Bhatt, A., Rahman, F., Meza-Torres, B., Litchfield, M. & de Lusignan, S., Mar 2021, In: British Journal of General Practice. 71, 704, p. e209-e218

    Research output: Contribution to journalArticlepeer-review

  4. Earlier diagnosis of lung cancer in a randomised trial of an autoantibody blood test followed by imaging

    Sullivan, F. M., Mair, F. S., Anderson, W., Armory, P., Briggs, A., Chew, C., Dorward, A., Haughney, J., Hogarth, F., Kendrick, D., Littleford, R., Mcconnachie, A., McCowan, C., Mcmeekin, N., Patel, M., Rauchhaus, P., Ritchie, L., Robertson, C., Robertson, J., Robles-Zurita, J. & 8 others, Sarvesvaran, J., Sewell, H., Sproule, M., Taylor, T., Tello, A., Treweek, S., Vedhara, K. & Schembri, S., 1 Jan 2021, In: European Respiratory Journal. 57, 1, 11 p., 2000670.

    Research output: Contribution to journalArticlepeer-review

Related by journal

  1. Interim findings from first-dose mass COVID-19 vaccination roll-out and COVID-19 hospital admissions in Scotland: a national prospective cohort study

    Vasileiou, E., Simpson, C. R., Shi, T., Kerr, S., Agrawal, U., Akbari, A., Bedston, S., Beggs, J., Bradley, D., Chuter, A., de Lusignan, S., Docherty, A. B., Ford, D., Hobbs, FD. R., Joy, M., Katikireddi, S. V., Marple, J., McCowan, C., McGagh, D., McMenamin, J. & 12 others, Moore, E., Murray, J. LK., Pan, J., Ritchie, L., Shah, S. A., Stock, S., Torabi, F., Tsang, R. SM., Wood, R., Woolhouse, M., Robertson, C. & Sheikh, A., 23 Apr 2021, In: The Lancet. 397, 10285, p. 1646-1657

    Research output: Contribution to journalArticlepeer-review

  2. School reopening without robust COVID-19 mitigation risks accelerating the pandemic

    Gurdasani, D., Alwan, N. A., Greenhalgh, T., Hyde, Z., Johnson, L., McKee, M., Michie, S., Prather, K. A., Rasmussen, S. D., Reicher, S., Roderick, P. & Ziauddeen, H., 27 Mar 2021, In: The Lancet. 397, 10280, p. 1177-1178 2 p.

    Research output: Contribution to journalLetter

  3. Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3

    Global Burden of Disease Health Financing Collaborator Network & Cevik, M., 23 Apr 2020, In: Lancet. Online First, 32 p.

    Research output: Contribution to journalArticlepeer-review

  4. The COVID-19 vaccines rush: participatory community engagement matters more than ever

    Burgess, R. A., Osborne, R. H., Yongabi, K. A., Greenhalgh, T., Gurdasani, D., Kang, G., Falade, A. G., Odone, A., Busse, R., Martin-Moreno, J. M., Reicher, S. & McKee, M., 10 Dec 2020, In: The Lancet. In Press

    Research output: Contribution to journalComment/debatepeer-review

  5. The UK needs a sustainable strategy for COVID-19

    Gurdasani, D., Bear, L., Bogaert, D., Burgess, R. A., Busse, R., Cacciola, R., Charpak, Y., Colbourn, T., Drury, J., Friston, K., Gallo, V., Goldman, L. R., Greenhalgh, T., Hyde, Z., Kuppalli, K., Majumder, M. S., Martin-Moreno, J. M., McKee, M., Michie, S., Mossialos, E. & 16 others, Nouri, A., Pagel, C., Pimenta, D., Popescu, S., Priesemann, V., Rasmussen, A. L., Reicher, S., Ricciardi, W., Rice, K., Silver, J., Smith, T. C., Wenham, C., West, R., Yamey, G., Yates, C. & Ziauddeen, H., 9 Nov 2020, In: The Lancet. In Press, 2 p.

    Research output: Contribution to journalComment/debate

ID: 259078608

Top