ICH after DAPT

Q: 57 years old male who has been recently started on Dual Anti-Platelet Therapy (DAPT) after his coronary artery stents is brought to emergency room (ER) with severe headache. CT scan showed intracranial hemorrhage (ICH). Platelet infusion should be ordered as bleeding probably happened due to DAPT.

A) True

B) False

Answer: B

Due to antiplatelet therapy, ICH does not require platelet transfusion. In fact, studies have shown that they can be harmful (see references #1 and #2).

Said that platelet transfusions may be given if clinician feels that it may help to reduce risks of postoperative bleeding in case patient is taken to the OR.

#surgery-critical-care

#hematology

#pharmacology

#neurology

#neuro-surgery

References:

1. Baharoglu MI, Cordonnier C, Al-Shahi Salman R, 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; 387:2605.

2. Eilertsen H, Menon CS, Law ZK, et al. Haemostatic therapies for stroke due to acute, spontaneous intracerebral haemorrhage. Cochrane Database Syst Rev 2023; 10:CD005951.

3. Mayer SA, Brun NC, Begtrup K, et al. Efficacy and safety of recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med 2008; 358:2127.