Baharoglu MI, et al. 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 May 9. pii: S0140-6736(16)30392-0. doi: 10.1016/S0140-6736(16)30392-0. [Epub ahead of print]
Key points (3-5):
- The multicentre, randomized-controlled Platelet Transfusion in Cerebral Haemorrhage (PATCH) study tested whether platelet transfusion could be beneficial in patients with intracerebral haemorrhage (ICH) with prior antiplatelet use.
- PATCH included 190 patients and showed that platelet transfusion was associated with an increased risk for death or dependence 3 months after ICH.
- Inhospital serious adverse events more often occurred in patients who received platelet transfusion and ICH volume growth at 24 hours was not significantly different between the two groups.
- Therefore, platelet transfusion should be avoided in ICH patients on antiplatelet therapy.
Comment (150-250 words):
Previous observational studies have suggested that the use of antiplatelet medication prior to an intracerebral haemorrhage (ICH) might be associated with a worse clinical outcome by increasing the volume of the bleeding. Platelet transfusion could serve to counteract this problem and is widely used in the emergency setting of acute bleeding events. The multicentre (The Netherlands, UK, France) Platelet Transfusion in Cerebral Haemorrhage (PATCH) is the first randomized study that tested whether platelet transfusion compared to standard care could reduce death or dependency rates in ICH patients with prior antiplatelet use (mostly aspirin). PATCH included 190 ICH patients and showed that patients receiving platelet transfusion (n=97) did not benefit but rather had an increased risk for death or dependence 3 months after ICH compared to patients who were treated with standard care (adjusted odds ratio: 2.05; 95% confidence interval: 1.18-3.56; p=0.0114). Moreover, inhospital serious adverse events occurred in 42% of patients who received platelet transfusion versus 29% in the control group. ICH volume growth at 24 hours was comparable between the two groups. The main limitations of this study are the small to moderate sample size, some slight group imbalances in clinical/ prognostic variables and missing information on platelet function. Nevertheless, these results clearly indicate that platelet transfusions could be harmful and should be avoided in ICH patients on antiplatelet therapy. It is yet unclear what has caused these unexpected results. Possible explanations include platelet transfusion related proinflammatory side effects or prothrombotic conditions. It should be interesting to further explore these issues. Importantly, another comparable randomised trial on this topic from Finland awaits finalisation.
References (< 5):
Baharoglu MI, Cordonnier C, Salman RA, de Gans K, Koopman MM, Brand A, Majoie CB, Beenen LF, Marquering HA7 Vermeulen M, Nederkoorn PJ, de Haan RJ, Roos YB; 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 May 9. pii: S0140-6736(16)30392-0. doi: 10.1016/S0140-6736(16)30392-0. [Epub ahead of print]