Thread by @namorrismd

Nice study on Thrombocytopenia and Clinical Outcomes in Intracerebral Hemorrhage. Helps further delineate risks for poor outcome after ICH among patients on antiplatelet agents. ahajournals.org/doi/full/10.11…

Over 1/2 of U.S. adults over 45 take antiplatelet agents (APA). ajpmonline.org/article/S0749-…. Studies show disparate results when investigating effect of APA on outcome. doi:10.1161/01.STR.0000231842.32153.74
doi:10.1161/01.STR.0000196991.03618.31

Plt transfusion is common for APA associated ICH, but not show to improve outcomes. PATCH study actually showed worse outcomes in patients who received platelets.

PATCH excluded patients likely to undergo surgery or with sig IVH (likely to require EVD), limiting generalizability to severe-associated ICHs.

Some suggest platelet activity should be checked since this is not affected in all patients onAPAs. Studies taking this approach show conflicting results in which Tx timing may mediate effect. @andynaidech has been a pioneer. rdcu.be/ce9bT
sciencedirect.com/science/articl…

Out meta-analysis showed no benefit to platelet transfusion in APA-associated ICH but was limited by considerable heterogeneity among studies. jns-journal.com/article/S0022-…

Worth noting that in a study of patients on aspirin undergoing crani for tumor resection, there were no increased hemorrhagic complications among pts that continued ASA compared to those who stopped prior to surgery or those that never took ASA. thejns.org/view/journals/…

So maybe need for crani should not be a strict exclusion criteria to future studies?

The current study in Stroke is important because it shows an interaction between APA use and thrombocytopenia on hematoma expansion and outcomes.

Thus, we likely need to be more nuanced in our approach to Plt transfusion in APA-associated ICH. Type of APA (single vs. dual, aspirin vs. clopidogrel, platelet activity/TEG results, comorbidities) might be important.

Excuse the typos. Still working on my tweetorial game.

@mjaffa_do @MDNeurocritcare @EM_NCC @emcrit @AndrewNaidech @neurocritical @EricLawson90 @caseyalbin @MikeA_42