New ‘PBM Column’ Examines Platelet Needs in Antiplatelet Therapy for Patients With Spontaneous ICH

AABB’s Transfusion Safety and Patient Blood Management (TS/PBM) Subsection recently released the latest article in its “PBM Column” series, which explores the complex considerations surrounding platelet transfusions for patients experiencing nontraumatic intracerebral hemorrhage (ICH) while on antiplatelet therapy.

In this complimentary resource, author Mark T. Friedman, DO, highlights that while platelet transfusions are commonly administered to patients with ICH, the practice remains controversial. Current European guidelines recommend transfusion only in cases where surgical intervention is planned, and recent studies have yielded mixed results regarding the efficacy of platelet transfusions in improving outcomes for patients on antiplatelet therapy presenting with either traumatic or spontaneous ICH.

Friedman continues with a discussion of the mechanisms by which antiplatelet medications such as aspirin and clopidogrel impair platelet function, potentially complicating management in ICH cases. A retrospective review of 97 patients in the United States with spontaneous ICH indicated that platelet transfusions were associated with negative outcomes (i.e., higher rates of mortality and neurological deterioration), although these differences were no longer significant in a cohort subanalysis of 62 patients matched for ICH severity. The study concluded that the usefulness of platelet transfusions in this patient population remains unclear.  

Further research, including a randomized European trial involving 190 patients presenting with spontaneous ICH on antiplatelet therapy, demonstrated that platelet transfusion was linked to increased mortality rates. The study's authors suggested that complications could arise because of the prothrombotic and proinflammatory effects of platelet transfusion leading to increased vascular permeability in their patients.

Finally, the authors of a meta-analysis of 16 included articles of more than 780 that were identified concluded that platelet transfusion after either traumatic or spontaneous ICH in patients on antiplatelet therapy has no clear benefit. Friedman concluded that, ultimately, health care facilities must weigh the existing evidence when evaluating their transfusion practices for patients with spontaneous ICH.

Additional PBM resources are available in AABB’s PBM Toolkit.