The common practise of giving patients with an acute intracerebral haemorrhage a platelet transfusion is not effective and might even be dangerous. That is the conclusion of a paper by an international group of researchers that was published in The Lancet. They specifically studied patients that were on antiplatelet drugs prior to having the bleeding.
The team, consisting of researchers from the Netherlands, the United Kingdom and France, set up a multicentre, open-label, masked-endpoint, randomised trial to study the effectiveness of a platelet transfusion in patients using antiplatelet therapy and having an acute spontaneous primary intracerebral haemorrhage. A common intervention, according to Yvo Roos, professor at the Amsterdam Medical Center and the last author of the study. “Many colleagues in America prescribe this treatment by default because ‘it makes sense’”. The 190 patients from 41 sites all received standard care, and 97 patients also received a platelet transfusion.
The results were surprising. Compared to the group that just received standard care, the patients who received a platelet transfusion had an odds ratio of death or dependence at 3 months of 2,05 (measured using the Modified Rankin Scale). These patients also had more adverse events: 29 per cent in de standard care group versus 42 per cent in de transfusion group. The authors don’t have a clear explanation for their results. They point to several mechanisms by which the transfusion can worsen instead of ameliorate the bleeding.
According to the researchers platelet transfusion cannot be recommended for people taking antiplatelet therapy before their intracerebral haemorrhage. “A number of colleagues should revise their treatment protocols straight away”, says Roos. This statement is supported by Calin I. Prodan, professor of Neurology at the University of Oklahoma Health Sciences Center and Veterans Administration Medical Center, who wrote a comment about Roos’ study. Both the researchers and Prodan refer to an ongoing study on the same subject of which the results are expected soon.
Sources: The Lancet en AMC