Platelet Transfusion vs. Standard Care After Acute Stroke due to Spontaneous Cerebral Hemorrhage Associated With Antiplatelet Therapy - PATCH
The goal of the trial was to evaluate platelet transfusion compared with standard care among patients with intracerebral hemorrhage while on antiplatelet therapy.
Contribution to the Literature: The PATCH trial showed that platelet transfusion was inferior to standard care among patients with intracerebral hemorrhage.
Patients with intracerebral hemorrhage while on antiplatelet therapy were randomized to platelet transfusion (n = 97) versus standard care (n = 93). The most common antiplatelet agent was aspirin in 73%.
- Total number of enrollees: 190
- Duration of follow-up: 3 months
- Mean patient age: 74 years
- Percentage female: 43%
- Percentage diabetics: 15%
- Patients 18 years or older with nontraumatic supratentorial intracerebral hemorrhage
- Glasgow Coma Scale score of 8–15
- Platelet transfusion initiated within 6 hours of symptoms
- Antiplatelet therapy (aspirin, clopidogrel, or dipyridamole) for the last 7 days
- Epidural or subdural hematoma, aneurysm, or arteriovenous malformation
- Planned surgical evacuation of intracerebral hemorrhage within 24 hours
- Intraventricular blood more than sedimentation in the posterior horns of the lateral ventricles
- Previous adverse reaction to platelet transfusion
- Use of vitamin K antagonist, history of coagulopathy, or thrombocytopenia
- Lacking mental capacity by national legal standards before intracerebral hemorrhage
The primary outcome, odds of death or dependence at 3 months, was higher in the platelet transfusion group versus the standard care group (adjusted odds ratio 2.05, 95% confidence interval 1.18–3.56; p = 0.011).
- Serious adverse event: 42% in platelet transfusion group versus 29% with standard care (p = NS)
- Death: 24% in platelet transfusion group versus 17% with standard care (p = NS)
Among patients with intracerebral hemorrhage while on antiplatelet therapy, platelet transfusion was inferior to standard care. Platelet transfusion was associated with an increased probability of death or disability, or serious adverse event.
Baharoglu MI, Cordonnier C, Salman RA, et al., on behalf of the 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;387:2605-13.
Keywords: Aspirin, Cerebral Hemorrhage, Dipyridamole, Glasgow Coma Scale, Platelet Aggregation Inhibitors, Platelet Transfusion, Primary Prevention, Stroke, Ticlopidine
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