====== Platelet transfusion for intracerebral hemorrhage ======

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
((Baharoglu MI, Cordonnier C, Al-Shahi Salman R, de Gans K, Koopman MM, Brand A,
Majoie CB, Beenen LF, Marquering HA, Vermeulen M, Nederkoorn PJ, de Haan RJ, Roos
YB; PATCH Investigators. 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 Jun
25;387(10038):2605-2613. doi: 10.1016/S0140-6736(16)30392-0. Epub 2016 May 10.
PubMed PMID: 27178479.
)).
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Mengel et al. investigated the hemostatic efficacy of combined [[desmopressin]] (1-deamino-8-D-arginine vasopressin) and [[platelet transfusion]] in reducing [[hematoma expansion]] in acute, [[spontaneous intracerebral hemorrhage]] under [[antiplatelet therapy]].

Single-center, nonrandomized study, performed between 2006 and 2014 in a Tertiary University Hospital of [[Tuebingen]].

[[Adult]] patients with intracerebral hemorrhage under antiplatelet treatment and follow-up CT at 24 ± 12 hours were included. Exclusion criteria included other intracerebral hemorrhage causes, anticoagulation, coagulopathy, or immediate surgery after baseline-CT.

Treatment with IV 1-deamino-8-D-arginine vasopressin (0.4 µg/kg) + platelet transfusion (2 U) within 60 minutes of intracerebral hemorrhage under antiplatelet treatment diagnosis on brain imaging.

Primary outcome was relative hematoma expansion from baseline to follow-up CT. Secondary outcomes included secondary intraventricular hemorrhage or hydrocephalus upon follow-up CT, thromboembolic events before discharge, and the 3-month functional outcome (assessed by modified Rankin Scale). One-hundred forty patients were included, 72 treated versus 68 controls. Times of symptom-onset-to-baseline-CT (hr) (median [interquartile range]: 3 [4] vs 5 [5]; p = 0.468) and follow-up CT (26 [18] vs 19 [12]; p = 0.352) were similar between groups. No between-group differences of total intracerebral hematoma expansion (%) (median [interquartile range]: 8.5 [12.4] vs 9.1 [16.5]; p = 0.825), intraparenchymal (10.7 [23.1] vs 9.2 [20.7]; p = 0.900), and intraventricular hematoma expansion (14.5 [63.2] vs 6.1 [40.4]; p = 0.304) were noted. Among patients with hematoma expansion greater than or equal to 33% compared with baseline, 16 (52%) received treatment versus 15 (48%) controls. The occurrence of hematoma expansion greater than or equal to 33% was similar between groups (p = 0.981). Rates of secondary intraventricular hemorrhage, hydrocephalus, and thromboembolic events were similar between groups. Treatment with 1-deamino-8-D-arginine vasopressin + platelet transfusion was not associated with the 3-month functional outcome (adjusted odds ratio, 1.570; 95% CI, 0.721-3.419; p = 0.309).

In line with the randomized Platelet Transfusion Versus Standard Care After Acute Stroke Due to Spontaneous Cerebral Hemorrhage Associated With Antiplatelet Therapy trial, our results suggest no hemostatic efficacy of early platelet transfusion in intracerebral hemorrhage under antiplatelet treatment. Contrary to results of preclinical and clinical no intracerebral hemorrhage studies, adjunct 1-deamino-8-D-arginine vasopressin showed no benefit in limiting hematoma expansion or improving functional outcome
((Mengel A, Stefanou MI, Hadaschik KA, Wolf M, Stadler V, Poli K, Lindig T,
Ernemann U, Grimm F, Tatagiba M, Ziemann U, Poli S. Early Administration of
Desmopressin and Platelet Transfusion for Reducing Hematoma Expansion in Patients
With Acute Antiplatelet Therapy Associated Intracerebral Hemorrhage. Crit Care
Med. 2020 Apr 16. doi: 10.1097/CCM.0000000000004348. [Epub ahead of print] PubMed
PMID: 32304415.)).
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A randomized control study(the PATCH trial)found no beneficial effect of platelet concentrate(PC)transfusion on the prognosis of patients with intracerebral hemorrhage(ICH)treated with anti-platelet agents(APAs). However, the trial excluded surgical cases. In this study, we examined the effect of PC on ICH, including patients who received surgical treatment.

A retrospective cohort analysis was performed in 23(11 males, 12 females)of 35 patients diagnosed with ICH and treated with APAs between January 2010 and December 2015 at the Department of Neurosurgery, Yamaguchi University Hospital. Twelve patients were excluded due to the use of anticoagulants or replenishment of coagulation factors.
RESULTS:

PC transfusion was administered in 12 cases(PC group)but not administered in 11(non-PC group). Conservative therapy at admission was used in 7 and 9 cases in the PC and non-PC groups, respectively, and none of these cases showed hematoma enlargement during conservative therapy. Surgical treatment was performed in 6 and 2 patients in the PC and non-PC groups, respectively, and hematoma enlargement occurred postoperatively in one patient in each group. Outcomes at 3 months after onset showed no significant difference between the groups(mRS 0-3:6 vs. 5 cases, p=0.34). Patients who received PC had no serious adverse events during hospitalization.

In this study, surgery after PC transfusion was performed without any problems. There was no difference in prognosis between patients who did and did not receive PC. These results suggest that surgery can be performed safely after PC transfusion
((Sugimoto K, Ishihara H, Shinoyama M, Sadahiro H, Suzuki M. [Effect of Platelet
Concentrate Transfusion on Prognosis of Patients with Intracerebral Hemorrhage
Treated with Anti-Platelet Agents]. No Shinkei Geka. 2017 Nov;45(11):965-970.
doi: 10.11477/mf.1436203629. Japanese. PubMed PMID: 29172201.
)).

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