Impact of GLP-1 receptor agonists on stroke, subarachnoid hemorrhage, and intracerebral hemorrhage: a propensity-matched multi-institutional cohort study.
Costa. Matias M; O'Leary. Sean S; Price. Anthony M AM; Young. Christopher C CC; Srinivasan. Visish M VM; Kan. Peter P
Key Findings
- In aneurysmal subarachnoid hemorrhage, GLP‑1‑RA use cut re‑bleeding risk by ~27% and mortality by ~60% at 6‑12 months
- In spontaneous intracerebral hemorrhage, GLP‑1‑RA use lowered hydrocephalus (~63%‑62% reduction) and seizures (~44%‑37% reduction) and cut death risk by about half
- In acute ischemic stroke, GLP‑1‑RA users had ~73% lower 6‑month mortality and reduced recurrence, hydrocephalus, and seizures
- Across all groups, GLP‑1‑RA users had 18%‑36% lower incidence of new strokes over 1‑2 years
Practical Outcomes
- For biohackers, the data suggest that adding a GLP‑1 receptor agonist such as tirzepatide after a stroke could improve survival and reduce complications, and might also help prevent future strokes. Use the same dosing approved for diabetes/weight loss and start as early as possible (within 8 weeks of the event), but always coordinate with a medical professional. Keep an eye on upcoming prospective trials for stronger proof.
Summary
A big data study looked at people who took GLP‑1 drugs like tirzepatide after different kinds of stroke or brain bleed. It found they were less likely to die, have repeat bleeding, seizures, or fluid buildup in the brain, and they also had a lower chance of having another stroke in the next one to two years. The safety profile was similar to people not on the drugs.
Abstract
The authors evaluated whether glucagon-like peptide-1 receptor agonists (GLP-1-RAs) improve outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH), spontaneous intracerebral hemorrhage (sICH), and acute ischemic stroke (AIS) and reduce the overall incidence of these events. This retrospective study leveraged TriNetX data (2014-2024) to identify patients with aSAH, sICH, or AIS. Individuals receiving exenatide, lixisenatide, semaglutide, dulaglutide, liraglutide, or tirzepatide within 8 weeks of diagnosis were propensity matched to controls. Outcomes (e.g., mortality, rebleeding/recurrence, seizures, hydrocephalus) were assessed at 6 and 12 months; the incidence rates of stroke types were examined at 1 and 2 years. For aSAH patients, GLP-1-RA use at 6 months reduced rebleeding (OR 0.73, p = 0.003) and mortality (OR 0.41, p < 0.001) and at 1 year lowered cognitive deficits (OR 0.63, p = 0.034) and mortality (OR 0.39, p < 0.001). In sICH patients, GLP-1-RAs decreased hydrocephalus (OR 0.37, p = 0.005) and seizures (OR 0.56, p = 0.007) at 6 months, with persistent benefits at 1 year (hydrocephalus, OR 0.38, p = 0.007; seizures, OR 0.63, p = 0.018), alongside lower mortality (OR 0.45-0.40, both p < 0.001) and rebleeding (OR 0.70-0.69, both p < 0.001) rates. In AIS patients, mortality fell at 6 months (OR 0.27, p < 0.001) and 1 year (OR 0.44, p < 0.001), with reduced recurrence (OR 0.60, p < 0.001) and lower hydrocephalus (OR 0.32, p < 0.001) and seizure (OR 0.43, p < 0.001) rates at 6 months. At 1 year, GLP-1-RA users had lower incidence rates of SAH (OR 0.64, p = 0.001), ICH (OR 0.62, p < 0.001), and AIS (OR 0.82, p = 0.003), which were sustained at 2 years (ORs 0.77-0.87, all p < 0.05). Adverse events were similar. GLP-1-RAs were associated with improved survival and fewer complications across stroke subtypes, plus reduced hemorrhagic and ischemic stroke incidence. Prospective trials are warranted to confirm these observations.
Study Information
pubmed
2025
2025-10-03T00:00:00.000Z
10.3171/2025.5.jns25786