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Acute ischemic stroke — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

HardEmergency MedicineAcute ischemic strokeUSMLE Step 3

A 66-year-old taking aspirin has a spontaneous supratentorial intracerebral hemorrhage. Platelet count is normal, and neurosurgery does not plan an emergency operation. Which platelet strategy is appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Manage without platelet transfusion for aspirin reversal

The best answer is “Manage without platelet transfusion for aspirin reversal”. For spontaneous ICH in an aspirin-treated patient not requiring emergency surgery and without severe thrombocytopenia, platelet transfusion is potentially harmful and should not be used routinely. This differs from selected emergency neurosurgical circumstances. Normal platelet count and the absence of planned emergency surgery are the decisive qualifiers in this scenario.

Reference: 2022 AHA/ASA Guideline for Spontaneous Intracerebral Hemorrhage: https://professional.heart.org/en/science-news/2022-guideline-for-the-management-of-patients-with-spontaneous-intracerebral-hemorrhage/top-things-to-know