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The antiplatelet medications (aspirin, clopidogrel, Aggrenox among others) are widely used to prevent blood vessel narrowing, clot formation and the resulting serious events such as heart attacks, ischemic (blockage-type) strokes and peripheral vascular disease (leg claudication). Over 10 millions of adults in the USA have a history of coronary artery disease (narrowing of arteries supplying the heart), heart attack or ischemic stroke. According to Agency for Healthcare Research and Quality, 19.3% of U.S. adults (about 43 million) reported taking aspirin every day or every other day in 2005. Among those who were ever told by a doctor that they have indicators of heart disease, 53.9% reported taking aspirin every day or every other day as compared with 14.8% of those who were never told by a doctor that they had indicators of heart disease. 

Although the overall increase in brain bleeding risk is lower with most antiplatelets when compared to anticoagulants, their use is still a risk factor. In most conditions when antiplatelet medications are medically indicated (history of ischemic stroke, coronary artery disease, peripheral artery disease), there is not much of an alternative. As always, it is important to discuss whether the individual patient really needs such blood thinner use, as well as the risk benefit ratio especially when there is a higher brain bleeding risk. One other thing to keep in mind is that using more than one blood thinner is only indicated in few special situations such as presence of a mechanical heart valve or transiently after placement of stents, among others. These issues should be carefully discussed with the prescribing physician in order to avoid unnecessary blood thinner use. 

Avoiding trauma, keeping the blood pressures under good control and complying with an overall well-planned medical management might help decrease the risk of brain bleeding even in patients who need antiplatelets for a valid reason.

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