PATCH trial: explanatory analyses

Benefits of lower neonatal platelet transfusion thresholds

“…The harm noted in RCTs and observational studies in premature neonates may be from disruption of balanced neonatal hemostasis, inflammatory mediators in stored components, and hemodynamic shifts associated with transfusion 2,3,9,10 . Other studies in adults and children have not indicated any benefit from increased platelet transfusions or dosing 11–15 . The PLADO trial showed that in patients with hypoproliferative thrombocytopenia given prophylactic transfusion at 10 × 10 9 /L, a higher platelet dose did not affect incidence of bleeding 11,12 .…”

“…In a study of adults with acute ICH on antiplatelet therapy, the PATCH trial's primary outcome found that the use of platelet transfusions (in addition to standard care) resulted in increased odds of death and dependence compared to standard care alone 14 . Although a follow‐up analysis of the PATCH trial indicates contribution from baseline imbalances for the detrimental effect of platelet transfusion, caution is still warranted 15 . With increasing evidence for role of platelets in not only hemostasis and thrombogenesis but also inflammation, further research on platelet transfusions is needed in neonates and adults.…”

Rethinking platelet transfusion practices

“…The PATCH trial reported that the use of platelet transfusion in intracranial hemorrhage (ICH) patients receiving antiplatelet drugs is associated with an increase in mortality and disability. 2,3 Magid-Bernstein et al have now investigated the role of ABO-incompatible platelet transfusion in the treatment of patients with ICH, a factor that was not examined in the original PATCH trial. Their analysis shows that patients who received ABOincompatible transfusions had significantly lower platelet recovery, increased odds of in-hospital mortality, and poorer neurological outcomes.…”

Intracerebral Hemorrhage: A Brief Evidence-Based Review of Common Etiologies, Mechanisms of Secondary Injury, and Medical and Surgical Management

“…[63][64][65][66] The PATCH trial found that patients with ICH who received platelet transfusions were actually likely to have poorer outcomes than those who did not. 67 As the guidelines suggest, one needs to be aware of the numerous risks of platelet transfusion and probably reserve transfusion for patients undergoing urgent neurosurgical intervention, 68 while more trials are needed to decide the safest option. Consideration for the half-life of the antiplatelet agent used and presence of active metabolites of the drugs may help decide the timing of administration of platelets, while single-donor platelets might be superior to pooled units.…”