Introduction: The impact of antiplatelet therapy (APT) on outcome following intracerebral hemorrhage (ICH) is controversial. Furthermore, the benefit of platelet transfusion in this patient population has been debated. Nevertheless, the relative impact of single-APT versus dual-APT has not been adequately assessed. Here, we evaluate the outcome and the impact of platelet transfusion in a subset of ICH patients on dual-APT.

Methods: Patients taking at least one antiplatelet agent were selected from a prospectively maintained ICH database. Patients were stratified into four groups: 1) single-APT without platelet transfusion, 2) single-APT with platelet transfusion, 3) dual-APT without platelet transfusion, and 4) dual-APT with platelet transfusion. Outcome was measured at hospital discharge and at 3 months after ICH onset, and was trichotomized into good outcome (mRS=3), poor outcome (mRS=4-5), and death (mRS=6). Fisher’s exact test was performed to compare outcome between groups.

Results: Patients on dual-APT did not have worse outcomes at discharge (p=0.8316), although there was a trend towards worse outcomes at 3-month follow-up (p=0.1778). When stratified into four groups according to single- vs. dual-APT and platelet transfusion, as described above, there was a significant effect on outcome (p=0.0265) that was driven by increased mortality in the dual-APT without platelet transfusion group. More specifically, 75% of dual-APT patients who did not receive platelets were dead at discharge, compared with only 14% of those who did receive platelet transfusion. Furthermore, 100% of non-transfused dual-APT patients were dead at 3-month follow-up, whereas only 40% of platelet-transfused dual-APT patients were dead at this time point.

Conclusions: Dual-APT may contribute to worse outcomes following ICH as compared with single-APT. Furthermore, platelet transfusion may be particularly beneficial in the subset of patients on dual-APT. Larger studies are warranted to more clearly establish the effect of dual-APT on outcome following ICH and to understand the benefit of platelet transfusion in these patients.

Patient Care: Although the benefit of platelet transfusion in patients with intracerebral hemorrhage is controversial, this research identifies a subset of ICH patients who may significantly benefit from such an intervention.

Learning Objectives: By the conclusion of this session, participants should be able to discuss the relative benefit of platelet transfusion in ICH patients on dual antiplatelet therapy, as compared with ICH patients on single antiplatelet therapy.

References: Creutzfeldt, Claire J, Jonathan R Weinstein, W T Longstreth, Kyra J Becker, Thomas O McPharlin, and David L Tirschwell. 2009. “Prior antiplatelet therapy, platelet infusion therapy, and outcome after intracerebral hemorrhage..” Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association 18(3): 221–228. Ducruet, Andrew F, Zachary L Hickman, Brad E Zacharia, Bartosz T Grobelny, Peter A DeRosa, Elissa Landes, Shuang Lei, Joyce Khandji, Sarah Gutbrod, and E Sander Connolly. 2010. “Impact of platelet transfusion on hematoma expansion in patients receiving antiplatelet agents before intracerebral hemorrhage..” Neurological Research 32(7): 706–710. Foerch, Christian, Matthias Sitzer, Helmuth Steinmetz, and Tobias Neumann-Haefelin. 2006. “Pretreatment with antiplatelet agents is not independently associated with unfavorable outcome in intracerebral hemorrhage..” Stroke; a journal of cerebral circulation 37(8): 2165–2167. Saloheimo, Pertti, Mikko Ahonen, Seppo Juvela, Juhani Pyhtinen, Eeva-Riitta Savolainen, and Matti Hillbom. 2006. “Regular aspirin-use preceding the onset of primary intracerebral hemorrhage is an independent predictor for death..” Stroke; a journal of cerebral circulation 37(1): 129–133. Toyoda, K, Y Okada, K Minematsu, M Kamouchi, S Fujimoto, S Ibayashi, and T Inoue. 2005. “Antiplatelet therapy contributes to acute deterioration of intracerebral hemorrhage..” Neurology 65(7): 1000–1004.