RCT

PATCH

Platelet Transfusion versus Standard Care in Acute Spontaneous Intracerebral Hemorrhage

Lancet, 2016 · Multicenter open-label randomized trial (n=190)

Clinical question

Does platelet transfusion improve outcomes in antiplatelet-associated spontaneous intracerebral hemorrhage?

Population: Adults with spontaneous ICH within 6 hours who had used antiplatelet therapy for >= 7 days prior
Intervention: Platelet concentrate transfusion within 90 minutes of brain imaging
Comparator: Standard supportive care without platelet transfusion
Primary outcome: Shift towards death or dependence on the modified Rankin Scale at 3 months
Result: Patients receiving platelet transfusion had significantly higher odds of death or dependence at 3 months (adjusted OR 2.05, 95% CI 1.18 to 3.56, P=0.0114) and higher in-hospital mortality (24% vs 17%).

What the trial found

Platelet transfusion in antiplatelet-associated non-operative ICH causes harm and increases mortality.

Current guideline position

Class III (Harm) recommendation in AHA/ASA and neurocritical care guidelines.

Clinical interpretation

Reversed empirical practice: routine platelet transfusion is contraindicated in non-surgical antiplatelet-associated ICH.

Clinical Context & Relevant Topics (2)

Disease Reference

Intracranial Hemorrhage: ICH & SAH

Spontaneous ICH vs Aneurysmal SAH, INTERACT-2/ATACH-2 blood pressure targets, emergency anticoagulant reversal, ENRICH minimally invasive evacuation, ISAT coiling, and Nimodipine for delayed cerebral ischemia.

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Blood Product Transfusion in Critical Care

Patient-specific RBC transfusion thresholds, current platelet/procedural thresholds, plasma/cryoprecipitate use, and the TRALI vs TACO diagnostic matrix.

View Topic Context →