PATCH
Trial question
What is the role of platelet transfusion after acute spontaneous primary intracerebral hemorrhage in people taking antiplatelet therapy?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
41.0% female
59.0% male
N = 190
190 patients (78 female, 112 male).
Inclusion criteria: adult patients with supratentorial intracerebral hemorrhage who had used antiplatelet therapy for the last 7 days and had a GCS score ≥ 8.
Key exclusion criteria: blood on brain imaging suggestive of epidural or subdural hematoma, or an underlying aneurysm or AVM; planned surgical evacuation of intracerebral hemorrhage within 24 h of admission; previous adverse reaction to platelet transfusion; history of coagulopathy; known thrombocytopenia; lacking mental capacity by national legal standards before intracerebral hemorrhage; or if death appeared imminent; infratentorial or large intraventricular hematomas.
Interventions
N=97 platelet transfusion (1-2 platelet concentrates depending on the type of antiplatelet therapy; COX inhibitor or ADP receptor inhibitor plus standard care).
N=93 standard care (standard care alone).
Primary outcome
Death or functional dependence at 3 months
72%
56%
72.0 %
54.0 %
36.0 %
18.0 %
0.0 %
Platelet
transfusion
Standard
care
Significant
increase ▲
NNH = 6
Significant increase in death or functional dependence at 3 months (72% vs. 56%; aOR 2.05, 95% CI 1.18 to 3.56).
Secondary outcomes
No significant difference in survival at 3 months (68% vs. 77%; OR 0.62, 95% CI 0.33 to 1.19).
No significant difference in poor outcome with mRS score 3-6 at 3 months (89% vs. 82%; OR 1.75, 95% CI 0.77 to 3.97).
No significant difference in intracerebral hemorrhage growth at 24 hours (2.01 mL vs. 1.16 mL; AD 0.85 mL, 95% CI -5.66 to 7.36).
Safety outcomes
Significant difference in serious adverse events (42% vs. 29%) and death during hospital stay (24% vs. 17%).
Conclusion
In adult patients with supratentorial intracerebral hemorrhage who had used antiplatelet therapy for the last 7 days and had a GCS score ≥ 8, platelet transfusion was inferior to standard care with respect to death or functional dependence at 3 months.
Reference
Baharoglu MI, Cordonnier C, Salman RA 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 Jun 25;387(10038):2605-2613.
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