Stroke recurrence and risk assessment after cerebral hemorrhage In 2013, Lancet published data on the number of stroke deaths in China, which was 1.7 million in 2010, accounting for 20% of the total number of deaths in the population and topping the list. In 2011, data from the National Stroke Center registry showed that hemorrhagic stroke accounted for 23.5% of strokes and ischemic stroke for 72.4% of strokes in China. In recent years, there have been great developments in the prevention and treatment of cerebral ischemia at home and abroad, and many high-quality RCT research results have guided clinical work. However, the research progress in the diagnosis and treatment of cerebral hemorrhage has been slow, and the mortality rate of cerebral hemorrhage abroad has been high, and the recurrence of stroke after cerebral hemorrhage may also be one of the reasons. A review of the domestic and international literature revealed that the few early small-scale clinical observational or retrospective studies abroad found that recurrence of cerebral hemorrhage in the basal ganglia was the most common, followed by lobar hemorrhage. A study in 2000 found that the annual recurrence rate of hemorrhagic stroke was 2.4% and the risk of ischemic stroke was 3.0% in 423 patients with ICH, with a 3.8-fold increased risk of rebleeding from lobar hemorrhage. Excluding lobar hemorrhage, the risk of recurrent ischemic stroke after hypertensive cerebral hemorrhage was significantly higher than that of hemorrhagic stroke. 2008 data from EMBASE/Medline showed that the rates of myocardial infarction, ischemic stroke, deep vein thrombosis, and pulmonary embolism after cerebral hemorrhage were 2.3%, 2.0%, 3.7%, and 1.1%, respectively. 2009 Elisabet Selection Sweden The results showed that the annual recurrence rate of stroke after cerebral hemorrhage was 5.1%, including 2.8% for ischemic stroke and 2.3% for hemorrhagic stroke, including lobar hemorrhage, which has a higher risk of recurrence. In the one-year follow-up of consecutive patients with cerebral hemorrhage, our group found that the recurrence rate of cerebral hemorrhage was 2.28% (including lobar hemorrhage, which has a high recurrence rate) and the incidence of ischemic stroke was 4.57%. Almost all data show that the risk of ischemic stroke after cerebral hemorrhage, especially after hypertensive cerebral hemorrhage, is higher than the risk of cerebral hemorrhage recurrence. These patients and their physicians share the same misconception that they should not use drugs to prevent cerebral infarction after cerebral hemorrhage for fear of causing a recurrence. It is not surprising to see patients who do not use aspirin for several years after a cerebral hemorrhage, but this is certainly related to the lack of high-quality, valuable clinical evidence. The relationship between antithrombotic therapy and cerebral hemorrhage has always been controversial, and aspirin is the most widely studied and clinically used antithrombotic drug. A meta-analysis of the results of 16 multicenter, randomized, controlled clinical trials on the treatment of cerebrovascular disease, in which the mean dose was 273 mg/d and the mean duration of dosing was 37 months. ASA was found to increase the incidence of cerebral hemorrhage by 12/10,000; it also reduced the incidence of myocardial infarction by 137/10,000; and the incidence of ischemic cerebral infarction by 39/10,000; thus indicating that the risk of cerebral hemorrhage after taking ASA is small relative to ischemic cardiovascular disease. 2006 study confirmed that cerebral hemorrhage recurrence was associated with lobar hemorrhage and was not associated with aspirin Robert’s study also confirmed that the use of aspirin after cerebral hemorrhage did not increase the recurrence of cerebral hemorrhage and reduced the incidence of ischemic vascular disease. But how to use antiplatelet therapy? When should it be used? There is a lack of evidence on the need for risk stratification of patients after cerebral hemorrhage. Exploring the safety of antiplatelet use after cerebral hemorrhage Given the evidence from domestic and international studies, Chu’s group conducted a safety study of aspirin intervention in high-risk patients at risk for ischemic stroke after cerebral hemorrhage. A total of 66 patients with hypertensive cerebral hemorrhage were enrolled in this study and randomly divided into 34 patients in the ASA intervention group for hypertensive cerebral hemorrhage (4 weeks after cerebral hemorrhage with aspirin 100 mg/day) and 32 patients in the NASA group for hypertensive cerebral hemorrhage (routine treatment after cerebral hemorrhage without aspirin); all enrolled cases were patients with cerebral hemorrhage in the basal ganglia region with ESSEN score ≥3. All patients were followed up at 30+2W, 30+4W, month 3, month 4, month 5, and month 6 to record medication administration, record MRS scores, BI index, and record safety events and endpoint events. The results showed that there was no significant difference in neurological recovery between the two groups after 1 year. 1 patient in the ASA intervention group had hematuria in the second week of dosing and discontinued the trial, and 2 cases in the NASA group had cerebral hemorrhage recurrence in the second month. Ischemic stroke events occurred in 4 patients (12.5%) in the NASA group at one-year follow-up; only 1 patient (3.2%) in the ASA intervention group had an ischemic event, with no significant difference between the two groups. The study concludes that the use of ASA after 30 days of onset in hypertensive cerebral hemorrhage patients on the basis of strict blood pressure control is safe, and although there was no statistically significant difference because of the limited number of cases, patients using ASA showed a trend toward a lower incidence of cerebral ischemia (3.2%:12.5%). In conclusion: ischemic stroke events after cerebral hemorrhage are higher than hemorrhage recurrence, and the use of aspirin for 30 days after cerebral hemorrhage to prevent ischemic events is safe and has a tendency to reduce the occurrence of ischemic stroke. Larger clinical trial studies are needed to confirm whether the use of aspirin after cerebral hemorrhage can prevent ischemic stroke events. However, we should not neglect ischemic stroke prevention after hypertensive cerebral hemorrhage.