American Board of Internal Medicine (ABIM) Certification Practice Exam

How many days after a hypertensive intracerebral hemorrhage can aspirin be safely administered in patients needing secondary prevention?

1. 10 days

2. 20 days

3. 30 days

4. 40 days

The correct answer is: 30 days

Aspirin can be safely administered for secondary prevention of cardiovascular events after a hypertensive intracerebral hemorrhage approximately 30 days post-incident. The rationale behind this timing is based on the need to minimize the risk of rebleeding while balancing the benefits of preventing thromboembolic events, such as stroke or myocardial infarction. Intracerebral hemorrhage carries the potential for subsequent complications, including increased intracerebral pressure and secondary strokes. Evidence suggests that delaying antiplatelet therapy like aspirin for at least 2 to 4 weeks (or around 30 days) post-hemorrhage significantly lowers the risk of recurrence of the hemorrhage while allowing adequate time for the resolution of hematoma and stabilization of the patient's condition. This timing supports the concept of a safe window that allows for the full clearance of any residual hemorrhagic risk associated with the acute event, thus enabling the patient to benefit more effectively from starting aspirin therapy for secondary prevention.