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

Baharoglu, Merih I; Cordonnier, Charlotte; Salman, Rustam Al-Shahi; Gans, Koen de; Koopman, M. M. W.; Brand, Anneke; Majoie, Charles B. L. M.; Beenen, Ludo F. M.; Marquering, Henk A.; Vermeulen, M.; Nederkoorn, Paul J.; Haan, Rob J. de; Roos, Yvo B.W.E.M.

doi:10.1016/s0140-6736(16)30392-0

Cited by 589 publications

(356 citation statements)

References 33 publications

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“…26 Among 97 patients who were randomised to receive platelet transfusion and 93 patients who received standard care, death and dependency was significantly higher in patients who received platelet transfusion (adjusted common odds ratio 2.05, 95% CI 1.18-3.·56; p=0.0114). Forty patients (42%) who received platelet transfusion had serious adverse events compared with 28 patients (29%) who received standard care.…”

Section: Anti-platelet-related Ichmentioning

confidence: 95%

Management of acute intracerebral haemorrhage – an update

et al. 2017

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Managing acute intracerebral haemorrhage is a challenging task for physicians. Evidence shows that outcome can be improved with admission to an acute stroke unit and active care, including urgent reversal of anticoagulant effects and, potentially, intensive blood pressure reduction. Nevertheless, many management issues remain controversial, including the use of haemostatic therapy, selection of patients for neurosurgery and neurocritical care, the extent of investigations for underlying causes and the benefi t versus risk of restarting antithrombotic therapy after an episode of intracerebral haemorrhage.

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Section: Anti-platelet-related Ichmentioning

confidence: 95%

Management of acute intracerebral haemorrhage – an update

et al. 2017

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“…In addition, the dual antiplatelet therapy may have the similar bleeding risk to oral anticoagulants [14,15]. However, the research results show that infusing platelets is not better than the standard treatment in patients with spontaneous intracranial hemorrhage according to the results in clinical practice [16].…”

Section: Antiplatelet Agents Related Cerebral Hemorrhagementioning

confidence: 98%

The Influence of Antithrombotic Drug Application on Intracranial Hemorrhage

Xu¹

2017

J Trauma Treat

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Thrombosis is caused by many diseases or complications, such as cerebrovascular disease, coronary heart disease, pulmonary thromboembolism, deep vein thrombosis after surgery and trauma, thus effective antithrombotic therapy has very important significance to the health of human beings. However, more and more clinical reports showed hemorrhage issues induced by antithrombotic treatment, especially in the central nervous system. Accordingly, in this paper, the relationship between common oral anticoagulants applied in clinic and the related problems about intracerebral hemorrhage will be reviewed.

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“…Indeed, platelet transfusions in the setting of hemorrhagic stroke, while taking an antiplatelet agent, were associated with an increased risk of mortality or dependence at 3 months (adjusted OR: 2.1, 95% CI: 1.2-3.6; p=0.01), consistent across all predefined subgroups, and remained so after adjusting for potential confounders. 51 While this adverse association could be spurious, and may have occurred purely by chance (due to the small sample size of the study), there is also a biological plausibility for platelet transfusions to induce harms, including increased risk of thromboembolism (4% vs 1%, p=0.17) 51 or potentiation of proinflammatory response. 46 At the very least, withholding "empirical" platelet transfusion in the setting of antiplatelet therapy-associated intracerebral hemorrhage appears to be safe.…”

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confidence: 98%

Context-dependent risks and benefits of transfusion in the critically ill

Harahsheh¹,

Ho²

2017

IJCTM

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Transfusion of red blood cells (RBCs) and other blood products to critically ill patients is common. Blood products are expensive, and not without risks. Recent evidence from high-quality multicenter randomized controlled trials confirmed the safety of allogeneic RBC transfusions, including the use of aged RBCs, and mild to moderate anemia for most stable and nonbleeding critically ill patients. Emerging evidence suggests that a liberal RBC transfusion target may have potential divergent effects on patient outcomes depending on their clinical context, with possible harms for patients with gastrointestinal bleeding due to portal hypertension and, conversely, benefits for patients with severe underlying cardiovascular diseases. Despite an apparent increased risk of bleeding in critically ill patients with deranged coagulation parameters and thrombocytopenia, recent studies suggested that fresh frozen plasma (FFP) and platelet transfusions may not be beneficial and, indeed, also not very effective in correcting these abnormalities. As for patients who have active severe critical bleeding, use of empirical 1:1:1 RBC: platelets: FFP transfusion appears justifiable in an attempt to reduce deaths as a result of exsanguination. In conjunction with platelet count and fibrinogen concentration, whole blood viscoelastic and platelet function tests are particularly useful to assist clinicians to rationalize FFP and platelet transfusions, when imminent death from exsanguination is not anticipated. Because the risks and benefits of blood product transfusion are heavily context-dependent, a thorough consideration of the characteristics and clinical status of the patients, in conjunction with viscoelastic and platelet function tests, is needed to rationalize the decision to transfuse (or withhold) blood products -very much in line with the move toward the practice of individualized or personalized medicine.

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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

Abstract: The Netherlands Organisation for Health Research and Development, Sanquin Blood Supply, Chest Heart and Stroke Scotland, French Ministry of Health.

Cited by 589 publications

References 33 publications

Management of acute intracerebral haemorrhage – an update

Management of acute intracerebral haemorrhage – an update

The Influence of Antithrombotic Drug Application on Intracranial Hemorrhage

Context-dependent risks and benefits of transfusion in the critically ill

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