This systematic review is published in Annals of Emergency Medicine under the section heading of “Best Available Evidence”, which somehow to me seems to pleasantly understate the unfortunate lack of data on this topic.
Intracererbral hemorrhage in the setting of antiplatelet use unfortunately is one of those clinical situations where outcomes are so dire that the philosophy seems to be to throw the kitchen sink of potentially beneficial interventions at patients. Use of clopidogrel, and to a lesser extent aspirin, are associated with increased hematoma size and poorer outcomes. Platelet transfusions, using measures of platelet aggregation activity, are demonstrated to improve and reverse inhibition in approximately two-thirds of patients. Therefore, it follows that platelet transfusions would improve outcomes in intracranial hemorrhage.
Unfortunately, the “best” evidence – which is mostly retrospective data of small cohorts – fails to demonstrate any improvement in mortality or morbidity. It is not possible to say from the data whether the platelets do not show efficacy at treating the extension of the ICH, or whether the poor outcomes result from parallel transfusion-related complications. The article concludes that withholding platelet transfusion should be considered to be within the standard of care. I tend to agree that resource-intensive treatments should be required to demonstrate benefit before widespread adoption, and therefore agree with these authors.
The authors additionally note a prospective, multicenter trial is underway.
“Does Platelet Transfusion Improve Outcomes in Patients With Spontaneous or Traumatic Intracerebral Hemorrhage?”