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Competing Interests: Declaration of Conflicting Interests:Ms. Tri has nothing to disclose. Ms. Albers reports grants from Astra Zeneca, during the conduct of the tool development; personal fees from Astra Zeneca, outside the submitted work. Dr. Koshman has nothing to disclose. Dr. Bucci reports personal fees from Astra Zeneca, outside of the submitted work. Dr. Kertland reports personal fees from Astra Zeneca, outside the submitted work. Dr. Semchuk reports grants from Astra Zeneca, during the conduct of the study; personal fees from Astra Zeneca, outside the submitted work.

Objective: To assess the risk of bleeding complications in patients treated with combination aspirin and heparin for cerebral ischemia., Design: A retrospective, cohort study., Setting: A large urban teaching hospital., Patients: One hundred charts of stroke patients who had received anticoagulation with or without aspirin therapy were identified from the Stroke Data Bank. Bleeding rates were compared between the two groups., Results: Forty-two patients who had received heparin and/or warfarin in combination with aspirin were compared with 33 patients who had received anticoagulation alone. The mean duration of anticoagulant therapy was 8.0 and 8.4 days, respectively. Bleeding rates were not different between the two groups: 23.8 percent (10/42) (p = 0.78) and 24.2 percent (8/33), respectively. Although the bleeding rate was substantial, there was only one major bleed (severe epistaxis) occurring in a patient receiving anticoagulation only. No patient had an intracerebral hemorrhage., Conclusions: Our data suggest that combination antithrombotic therapy is safe in a controlled, inpatient setting.

Objective: To observe and characterize the blood pressure (BP)-lowering and adverse hemodynamic and/or central nervous system effects of intravenous bolus doses of labetalol in hemorrhagic stroke patients., Design: Observational, prospective, pilot survey conducted over an eight-week period., Setting: Surgical intensive care unit., Participants: Patients admitted with an intracerebral or subarachnoid hemorrhage., Main Outcome Parameters: Absolute decline in systolic BP (SBP) and diastolic BP (DBP), time to peak reduction in SBP and DBP, and adverse hemodynamic and mental status changes., Results: Labetalol at doses between 5 and 25 mg lowered SBP by 6-19 percent (baseline 152-184 mm Hg) and DBP by 3-26 percent (baseline 50-99 mm Hg). Adverse hemodynamic or mental status changes were not detected following labetalol administration., Conclusions: Small (< or = 25 mg) intravenous bolus doses of labetalol produce mild decreases in BP in hemorrhagic stroke patients.