Summary Background Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention. Funding British Heart Foundation.

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As knowledge about the biological foundation of the modern patriarchal gender order is increasingly challenged within late-modern social worlds enclaves persist in which men and women can attempt to recreate understandings of the ''natural'' basis of sex difference. Within ''Power Gym,'' male boxers were able to symbolize their bodies and behaviors in such a manner. The language and logic of popular scientific discourses authored and authorized notions of an ''innate'' manhood. The ability to instrumentally deploy one's manliness in symbolically legitimate ways could then be represented and emotionally experienced as a man's biological right and obligation. Through scripted performances of ''mimetic'' violence and self-bullying, the boxers were able to experience this discursive naturalness and carve out a masculinity-validating social enclave. As such, they accessed a ''patriarchal dividend'' by securing a local pastiche hegemony in which discourses surrounding men's natural place as physically and psychologically dominant remained largely uncontested. Through the reflexive appropriation of ''science,'' within appropriate subcultural codes, these men could negotiate taboos and restrictions that are characteristic of late-modern social worlds. When considered in this way, the power of ''scientific'' truth claims to explain and justify a certain level of violence, aggression, and behaviors coded as masculine, comes to the fore.

Within this paper I draw on short vignettes and quotes taken from a two--year ethnographic study of boxing to think through the continuing academic merit of the notion of the male preserve. This is an important task due to evidence of shifts in social patterns of gender that have developed since the idea was first proposed in the 1970s. In aligning theoretical contributions from Lefebvre and Butler to discussions of the male preserve, we are able to add nuance to our understanding of how such social spaces are engrained with and produced by the lingering grasp of patriarchal narratives. In particular, by situating the male preserve within shifting social processes, whereby certain men's power is increasingly undermined, I highlight the production of space within which narratives connecting men to violence, aggression and physical power can be consumed, performed and reified in a relatively unrestricted form. This specific case study contributes to gender theory as an illustration of a way in which we might explore and understand social enclaves where certain people are able to lay claim to space and power. As such, I argue that the notion of the male preserve is still a useful conceptual, theoretical and political device especially when considered as produced by the tyranny of gender power through the dramatic representation and reification of behaviours symbolically linked to patriarchal narrations of manhood.

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy. Methods RESTART was a prospective, randomised, open-label, blinded-endpoint, parallel-group trial at 122 hospitals in the UK that assessed whether starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. For this prespecified subgroup analysis, consultant neuroradiologists masked to treatment allocation reviewed brain CT or MRI scans performed before randomisation to confirm participant eligibility and rate features of the intracerebral haemorrhage and surrounding brain. We followed participants for primary (recurrent symptomatic intracerebral haemorrhage) and secondary (ischaemic stroke) outcomes for up to 5 years (reported elsewhere). For this report, we analysed eligible participants with intracerebral haemorrhage according to their treatment allocation in primary subgroup analyses of cerebral microbleeds on MRI and in exploratory subgroup analyses of other features on CT or MRI. The trial is registered with the ISRCTN registry, number ISRCTN71907627.