The role of platelet transfusions after intracranial hemorrhage in patients on antiplatelet agents: a systematic review and meta-analysis

Department of Anaesthesia and Intensive Care, University of Pisa, Pisa Italy; Department of Anaesthesia and Intensive Care, Bufalini Hospital, Cesena, Italy. Electronic address: etruscabrogi@gmail.com. NeuroTrauma Intensive Care Unit, Department of Anaesthesia, Emergency and Critical Care, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy. Department of Surgery, University of Pisa, Pisa, Italy. Department of Anaesthesia and Intensive Care, Bufalini Hospital, Cesena, Italy. Department of Anaesthesia and Intensive Care, University of Pisa, Pisa Italy.

World Neurosurg. 2020
PICO Summary

Population

Adult patients on antiplatelet agents (APA) with traumatic brain injury (TBI) or spontaneous intracranial hemorrhage (ICH), (16 clinical trials).

Intervention

Platelet transfusion (PLT).

Comparison

No platelet transfusion.

Outcome

A significant difference was observed between the two groups only for hematoma expansion: standardized risk difference was -0.10 in favor of PLT transfusion. The same results were observed when performing subgroups analyses according to the type of bleeding mechanism. The use of PLT in patients on APA affected by intracranial hemorrhage seemed to have no clear beneficial effect for the outcomes evaluated; conversely, PLT appeared to slightly increase the odds for adverse events of thromboembolic origin, even though not significantly.
Abstract
The current evidence suggests that Antiplatelet agents (APA) slightly increase the risk of death and disease progression in patients with traumatic (TBI) or spontaneous intracranial hemorrhage (ICH). Disappointingly there is little evidence that APA reversal with platelet transfusion (PLT) may improve the outcome. In this systematic review and meta-analysis, our goal was to evaluate the differences in mortality, severe disability, and hematoma expansion related to PLT transfusion. We retrieved randomized, or cohort studies comparing adult patients on APA with TBI or ICH who were treated with PLT or not. We calculated the standardized Risk Difference (RD) and 95% CI. A random-effects model was applied to analyze the data. The heterogeneity of the retrieved trials was evaluated through the I(2) statistic. Our review finally included 16 clinical trials. We observed a significant difference between the two groups only for hematoma expansion: RD was -0.10 (10%; 95% CI: -0.14 to -0.05; P<0.0001; I(2)=0.90) in favor of PLT transfusion. Performing subgroups analyses according to the type of bleeding mechanism, we observed the same results. The use of PLT in patients on APA affected by intracranial hemorrhage seemed to have no clear beneficial effect for the outcomes evaluated; conversely, PLT appeared to slightly increase the odds for adverse events of thromboembolic origin, even though not significantly.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine