A 71-year-old man presented to the emergency room with chest pain and underwent a successful PCI procedure with stent placement. After 24 hours, he became drowsy and disoriented, and a CT scan revealed an acute subdural hematoma. While platelet transfusions may partially reverse the effects of clopidogrel, clinical trials found they increase mortality and worse outcomes in ICH patients on antiplatelets. Guidelines do not recommend for or against platelet transfusions for ICH from antiplatelets, and antiplatelet therapy should be restarted one month after ICH with close monitoring.

1. • 71-year-old man was admitted to the emergency room with sudden
onset retrosternal pain with radiation to back appeared for 14 hours.
• At presentation, he was conscious GCS 15, vitals were stable.

3. • The patient underwent primary percutaneous coronary intervention
(PCI) with placement of five stents in total, without peri-procedural
complications.
• Dual antiplatelet therapy was continued after percutaneous coronary
intervention.
• After the procedure, his vital signs and neurological status remained
stable.
• Twenty-four hours later of hospitalization, the patient became drowsy
and disoriented with GCS of E3V2M5.

4. • Brain computed tomography
(CT) scan revealed a right
temporoparietal acute
subdural hematoma with
mild mass effect.
• Laboratory investigations
including hemogram, INR,
APTT were normal.

5. • Risk factors for anti-platelet induced ICH?
• Role of platelet transfusions?
• Other strategies?
• When should antiplatelet therapy be restarted for patients who
experienced ICH, if at all?

7. • There is currently no approved therapy that can rapidly reverse the
effect of antiplatelet agents.
• Role of platelet transfusion-not known correctly
• Clinical practice guidelines neither recommend for or against platelet
transfusion for ICH occurring in the setting of antiplatelet use .

8. • Randomized trial of platelet transfusion for antiplatelet treated
patients with acute intracerebral hemorrhage (<6 hours after onset)
• Higher mortality, Higher mRS score, higher median ICH growth rate in
those receiving platelet transfusions
• After the findings of the PATCH trial, platelet transfusion cannot be
recommended for the treatment of acute intracerebral haemorrhage in
people taking antiplatelet therapy

9. • In vitro studies suggested that platelet transfusion could partially
reverse the antiplatelet effect of clopidogrel or prasugrel, but in vivo
data are lacking.
• On the other hand, platelet transfusion was ineffective in reversing
ticagrelor’s antiplatelet effect.

11. • Strategies recommended – start
with low dose Aspirin and restart
DAPT with aspirin plus clopidogrel,
one month after intracranial
hemorrhage in acute coronary
syndrome patients with drug-
eluting stent implantation shorter
than 3 months ago and continue
DAPT until the minimal advised
duration in reducing the risk and
manage bleeding complications
IC Bleed
Stent
thrombosis