title: Impact of platelet transfusion on hematoma expansion in patients receiving antiplatelet agents before intracerebral hemorrhage.
abstract: OBJECTIVE
  Patients receiving antiplatelet medications are reported to be at increased risk for hematoma enlargement and worse clinical outcomes following intracerebral hemorrhage (ICH). While platelet transfusions are frequently administered to counteract qualitative platelet defects in the setting of ICH, conclusive evidence in support of this therapeutic strategy is lacking. In fact, platelet transfusions may be associated with adverse effects, and represent a finite resource. We sought to determine the clinical efficacy of platelet transfusion and its impact on systemic complications following ICH in a cohort of patients receiving antiplatelet medications.
  
  
  METHODS
  We retrospectively analysed the medical records of 66 patients admitted to our institution from June 2003 to July 2008 who suffered a primary ICH while receiving antiplatelet (acetylsalicylic acid and/or clopidogrel) therapy. The primary outcome was the rate of significant (>25% increase from admission) hematoma expansion in transfused (n=35) versus non-transfused (n=31) patients. Discharge modified-Rankin score (mRS) and the rates of systemic complications were also assessed.
  
  
  RESULTS
  There were no statistically significant differences in rates of hematoma expansion between cohorts, nor were there differences in demographic variables, systemic complications or discharge mRS. Subgroup analysis revealed that there was a higher rate of hematoma expansion in the clopidogrel cohort (p=0.034) than in the cohort of patients receiving aspirin alone.
  
  
  CONCLUSIONS
  This study suggests that platelet administration does not reduce the frequency of hematoma expansion in ICH patients receiving antiplatelet medications. This lack of efficacy may relate to transfusion timing, as a significant proportion of hematoma expansion occurs within 6 hours post-ictus. Additionally, the increased rates of hematoma expansion in the clopidogrel cohort may relate to its prolonged half-life. A larger, prospective study is warranted.
authors.affiliation: Department of Neurological Surgery, Columbia University, New York, NY 10032, USA.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Ducruet
authors.forename: Zachary L
authors.initials: ZL
authors.lastname: Hickman
authors.forename: Brad E
authors.initials: BE
authors.lastname: Zacharia
authors.forename: Bartosz T
authors.initials: BT
authors.lastname: Grobelny
authors.forename: Peter A
authors.initials: PA
authors.lastname: DeRosa
authors.forename: Elissa
authors.initials: E
authors.lastname: Landes
authors.forename: Shuang
authors.initials: S
authors.lastname: Lei
authors.forename: Joyce
authors.initials: J
authors.lastname: Khandji
authors.forename: Sarah
authors.initials: S
authors.lastname: Gutbrod
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000009:adverse effects* / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000628:therapy*; D000077144:Clopidogrel; D016208:Databases, Factual; D005260:Female; D006406:Hematoma / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D017713:Platelet Transfusion; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin