• Etrusca Brogi, Davide Corbella, Federico Coccolini, Emiliano Gamberini, Emanuele Russo, Vanni Agnoletti, and Francesco Forfori.
• Department of Anaesthesia and Intensive Care, University of Pisa, Pisa, Italy; Department of Anaesthesia and Intensive Care, Bufalini Hospital, Cesena, Italy. Electronic address: etruscabrogi@gmail.com.
• World Neurosurg. 2020 Sep 1; 141: 455-466.e13.

AbstractThe evidence suggests that antiplatelet agents (APA) slightly increase the risk of death and disease progression in patients with traumatic brain injury or spontaneous intracranial hemorrhage (ICH). There is little evidence that APA reversal with platelet (PLT) transfusion may improve the outcome. In this systematic review and meta-analysis, our goal was to evaluate the differences in mortality, severe disability, and hematoma expansion related to PLT transfusion. We retrieved randomized or cohort studies comparing adult patients on APA with traumatic brain injury or ICH who were treated with PLT or not. We calculated the standardized risk difference and 95% confidence interval. A random-effects model was applied to analyze the data. The heterogeneity of the retrieved trials was evaluated through the I2 statistic. Our review included 16 clinical trials. We observed a significant difference between the 2 groups only for hematoma expansion: risk difference was -0.10 (10%; 95% confidence interval, -0.14 to -0.05; P < 0.0001; I2 = 0.90) in favor of PLT transfusion. Performing subgroups analyses according to the type of bleeding mechanism, we observed the same results. The use of PLT in patients on APA affected by ICH seemed to have no clear beneficial effect for the outcomes evaluated; conversely, PLT seemed to slightly increase the odds for adverse events of thromboembolic origin, even although not significantly.Copyright © 2020 Elsevier Inc. All rights reserved.

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