title: Is Platelet Transfusion Effective in Patients Taking Antiplatelet Agents Who Suffer an Intracranial Hemorrhage?
abstract: BACKGROUND
  Patients taking antiplatelet agents (APAs) with intracranial hemorrhage (ICH) may be treated with platelet transfusion.
  
  
  OBJECTIVE
  We conducted a systematic review of the use of platelet transfusion in the management of APA-related ICH.
  
  
  METHODS
  We searched the Cochrane, Medline, Embase, and CINAHL databases. Included studies were randomized, case-controlled, or cohort studies comparing outcomes in adult patients with APA-related ICH who received or did not receive platelet transfusion. Study quality was measured using appropriate scores. The primary outcome of interest was in-hospital mortality rate. Secondary outcomes included rates of craniotomy, neurological, medical, or radiological deterioration; mean length of hospital stay, delayed mortality, and functional status at discharge. We reported proportions, medians with interquartile ranges, and pooled odds ratios with their 95% confidence intervals. p values < 0.05 were considered statistically significant.
  
  
  RESULTS
  There were no randomized controlled trials. Seven retrospective cohort studies (four traumatic, three primary ICH) were included. For APA-related traumatic ICH, the pooled odds ratio (OR) for in-hospital mortality with platelet transfusion was 1.77 (95% confidence interval [CI] 1.00-3.13). There were no statistically significant differences for secondary outcomes except for proportion with medical decline (6/44 vs. 2/64; p = 0.006). For APA-related primary ICH, the pooled OR for in-hospital mortality with platelet transfusion was 0.49 (95% CI 0.24-0.98). There were no statistically significant differences for most secondary outcomes between the two groups. These studies had important methodological limitations.
  
  
  CONCLUSIONS
  The evidence for platelet transfusion in APA-related ICH was inconclusive due to methodological limitations.
authors.affiliation: Emergency Department, Jurong Health Services, Singapore.
authors.forename: Lim Beng
authors.initials: LB
authors.lastname: Leong
authors.affiliation: Emergency Department, Tan Tock Seng Hospital, Singapore.
authors.forename: Teng Kuan Peng
authors.initials: TK
authors.lastname: David
mesh_terms: D001804:Blood Transfusion, Autologous; D006259:Craniocerebral Trauma / Q000150:complications; D017052:Hospital Mortality; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000628:therapy*; D007902:Length of Stay / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017713:Platelet Transfusion
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: antiplatelet agents; intracranial hemorrhage; platelet transfusion