Abstract Number: Esoc2026ot204 Antiplatelet Secondary Prevention International Randomised Study After Intracerebral Haemorrhage (Aspiring): Investigator-Initiated, Multicentre, Pragmatic, Prospective, Randomised, Parallel Group, Open Clinical Trial

Abstract Background and aims Survivors of stroke due to spontaneous intracerebral haemorrhage (ICH) are at high risk of further major adverse cardiovascular or cerebrovascular events (MACE). In the REstart or STop Antithrombotics Randomised Trial (RESTART, www.RESTARTtrial.org) involving people with vascular disease and ICH associated with antithrombotic (antiplatelet or anticoagulant) agents, starting antiplatelet therapy was safe and seemed to reduce the risk of MACE. An external pilot phase of ASPIRING (NCT04522102) confirmed feasibility of recruiting a broader population. Methods The ASPIRING main phase aims to provide definitive evidence of the superiority of starting antiplatelet agent monotherapy versus avoiding antiplatelet agents in addition to standard care to prevent MACE for all ICH survivors. Results We aim activate 178 sites to recruit ≥4,148 people aged ≥18 years, who survive ≥24 hours after symptomatic ICH who have not taken antithrombotic therapy within the preceding 24 hours. Central computerised randomisation assigns participants (1:1) to start or to avoid antiplatelet monotherapy (with aspirin or clopidogrel). Participants are followed for the primary outcome of MACE (vascular death or hospitalisation due to non-fatal stroke or non-fatal myocardial infarction) for 1-5 years. Conclusions Participants are followed for the primary outcome of MACE (vascular death or hospitalisation due to non-fatal stroke or non-fatal myocardial infarction) for 1-5 years. Conflict of interest