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Evidence summaries

Haemostatic Therapies for Acute Spontaneous Intracerebral Haemorrhage

Platelet transfusion appears hazardous in comparison to standard care for antiplatelet-associated acute intracerebral haemorrhage (ICH). There is no evidence of either benefit or harm from other haemostatic therapies for ICH. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 12 RCTs involving 1732 patients. There were 7 RCTs of blood clotting factors vs. placebo or open control (n=1480), 3 RCTs of antifibrinolytic drugs vs. placebo or open control (n=57), one RCT of platelet transfusion vs. open control (n=190), and one RCT of blood clotting factors vs. fresh frozen plasma (n=5). In the RCT of platelet transfusion vs. open control for acute spontaneous ICH associated with antiplatelet drug use, there was a significant increase in death or dependence at day 90 (70/97 versus 52/93; RR 1.29, 95% CI 1.04 to 1.61; n=190). All findings were non-significant for blood clotting factors vs. placebo or open control for acute spontaneous ICH with or without surgery, for antifibrinolytic drugs vs. placebo or open control for acute spontaneous ICH, and for clotting factors vs. fresh frozen plasma for acute spontaneous ICH associated with anticoagulant drug use.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment).

    References

    • Al-Shahi Salman R, Law ZK, Bath PM et al. Haemostatic therapies for acute spontaneous intracerebral haemorrhage. Cochrane Database Syst Rev 2018;4():CD005951. [PubMed]

Primary/Secondary Keywords