2026 Eastern States Conference

Authors: Jordan Childress, PharmD; Joseph DiBlasi, PharmD, MBA, BCPS; Karen Frock, PharmD, BCCCP
Objective: This study evaluates adherence to guidelines for platelet transfusion in adults with spontaneous intracerebral hemorrhage (ICH) on antiplatelet therapy prior to admission and assesses associated clinical outcomes such as mortality, hematoma expansion, and thrombotic events.
Self-assessment Question: According to the American Heart Association (AHA)/American Stroke Association (ASA) guidelines, when are platelet transfusions recommended for patients on antiplatelet therapy who present with spontaneous intracerebral hemorrhage? 
Background: The PATCH trial showed increased mortality with platelet transfusion in spontaneous ICH. As a result, guidelines do not recommend routine administration. Platelet transfusion use in this population has not been evaluated at WellSpan York Hospital.
Methods: This is a retrospective cohort study of patients 18 years or older with a diagnosis of spontaneous ICH at WellSpan York Hospital from 06/1/2022 to 11/30/2025. This study was IRB exempt. Patients were excluded if they had a platelet count of less than 100,000/mcL, were using anticoagulants, or were not receiving antiplatelet therapy within 7 days of admission. The primary outcome was guideline adherence which was defined as no platelet transfusion and no emergent neurosurgical intervention or platelet transfusion within 24 hours of admission with neurosurgical intervention. Secondary outcomes included 90-day survival, survival to hospital discharge, and hematoma expansion on 24-hour head computed tomography. Safety outcomes included documentation of transfusion reactions and new thrombotic events. Comparative statistics between cohorts will be analyzed. Descriptive statistics were utilized for data collection and analysis.
Results: A total of 140 patients were evaluated for inclusion. Most exclusions were due to lack of antiplatelet use within 7 days of admission and/or outpatient anticoagulant use, resulting in 47 patients included in the study. Among included patients, the majority were receiving aspirin (83%) in comparison to other antiplatelet agents and had supratentorial ICH (74.5%) bleeding. A neurosurgical intervention within 24 hours of ICH was performed in 21.3% of patients. Guideline adherence was observed in 49% of patients with the most common reason for non-adherence being platelet administration without intervention. There were no differences in secondary outcomes. Thrombotic events occurred in 15% of patients receiving platelets.
Conclusions: Guideline adherence was present in about half of the patient population. There was no difference in secondary outcomes such as 90-day mortality, hematoma expansion, or safety outcomes. Future implications include additional research in a larger patient population as well as provider engagement with guideline recommendations.