Platelet Transfusion Not Recommended for Intracranial Hemorrhage
The PATCH trial was a multicenter randomized trial involving 41 hospitals in the Netherlands, United Kingdom, and France that investigated the effectiveness of platelet transfusion for patients on antiplatelet medications who developed intracranial hemorrhage (ICH).
The clinical trial included 190 patients who presented within 6 hours of ICH symptom onset if they had used antiplatelet therapy for at least 7 days beforehand and had a Glasgow coma scale score of at least 8. The protocol required platelet transfusion to be initiated within 6 h of ICH symptom onset and within 90 min of diagnostic brain imaging.
Of the patients receiving antiplatelet therapy, 71 were taking aspirin alone, 18 aspirin plus dipyridamole, 4 clopidogrel alone and 3 aspirin plus clopidogrel. Patients taking aspirin, with or without dipyridamole, received one platelet concentrate (equivalent to five donor units), whereas patients taking clopidogrel, with or without another antiplatelet drug, received two platelet concentrates.
The primary outcome was a shift toward death or dependence, rated on the modified Rankin Scale (mRS) at 3 months. The odds of death or dependence at 3 months were higher in the platelet transfusion group than in the standard care group (OR 2.05; 95% CI 1.18 - 3.56, P = .0114).
Serious adverse events during the hospital stay occurred in 42% of patients who received platelet transfusions and 29% of those who received standard care. In-hospital mortality was 24% in participants assigned to platelet transfusion and 17% in those assigned to standard care. Twenty four percent of patients assigned to platelet transfusion died during the hospital stay compared to 17% who received standard care alone.
The authors concluded that platelet transfusion seemed inferior to standard care for patients who develop intracranial hemorrhage while taking antiplatelet therapy. Platelet transfusion could not be recommended for this indication.
Reference
Baharoglu M et al. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial, Lancet 2016; 387:2605-13.
