Authors’ Conclusion

“Platelet transfusion seems inferior to standard care for people taking antiplatelet therapy before intracerebral hemorrhage. Platelet transfusion cannot be recommended for this indication in clinical practice.”

Key Results

The study included 190 patients randomized, with 97 in the platelet transfusion group and 93 in the standard care group. The mean patient age was 74 years.

Primary Outcome:

• Odds of death or dependence (mRS 4–6) were greater in the platelet transfusion group.
• Unadjusted odds ratio of mRS 4–6 was 1.84 (95% CI; 1.10–3.08, P=0.02) in the platelet transfusion group.
• Adjusted odds ratio of mRS 4–6 was 2.05 (95% CI; 1.18–3.56, P=0.0114) in the platelet transfusion group.

Secondary Outcomes:

• Alive at three months: 68% in the platelet transfusion group versus 77% in the standard care group; odds ratio 0.62 (95% CI; 0.33–1.19, P=0.15).
• mRS 4–6 at three months: 72% versus 56%; odds ratio 2.04 (95% CI; 1.12–3.74, P=0.0195).
• mRS 3–6 at three months: 89% versus 82%; odds ratio 1.75 (95% CI; 0.77–3.97, P=0.18).
• Median ICH growth at 24 hours (mL): 2.01 (0.32–9.34) in the platelet transfusion group (n=80) versus 1.16 (0.03–4.42) in the standard care group (n=73) (P=0.81).

Transfusion Issues: One patient had a minor transfusion reaction; there was no difference in thrombotic complications (four in platelet transfusion group versus one in standard care).

Serious Adverse Events: 42% in the platelet transfusion group versus 29% in the standard care group; odds ratio 1.79 (95% CI; 0.98–3.27) in the intention-to-treat analysis.

Evidence-Based Medicine Commentary

Emergency Department Patients: It is not clear if these patients were ED patients as it was not explicitly stated in the paper. It seems likely that they were given the nature of the complaint.

Consecutive Recruitment: There was no documentation on whether the patients were recruited consecutively. The publication does say that PATCH investigators did not need to keep a screening log. Therefore, we are unable to know if there was selection bias.

Additional Data: The authors say in their discussion that a similar randomized control trial is nearing completion. ClinicalTrials.gov shows that no results are available, and the page says, “The recruitment status of this study is unknown. The completion date has passed, and the status has not been verified in more than two years.”⁴

Bottom Line: Transfusion of platelets in patients with nontraumatic intracerebral hemorrhage cannot be recommended based on the available evidence.

Case Resolution

You discuss the care with the patient and her family. Neurosurgery is contacted, no platelets are transfused, and she is transferred to the intensive care unit.