The role of platelet transfusion after intracerebral hemorrhage associated with antiplatelet therapy remains undefined. A randomized, open-label, multicenter parallel-group trial compared 3-month functional outcome and mortality and 24-hour hemorrhage growth in patients with an acute, spontaneous, supratentoral intracerebral hemorrhage and at least 7 days of prior antiplatelet therapy. Patients were randomized to receive either standard medical management (97 patients) or standard management plus transfusion of platelets within 6 hours of ictus (93 patients). Ordinal logistic regression analysis of the shift in 3-month functional outcomes showed a statistically significant shift toward death or dependence in the platelet transfusion group (OR 1.84, 95% CI p=0.02). Hemorrhage growth at 24 hours and 3 month survival did not differ between the groups. mRS distribution was similar in patients getting platelet transfusion at 0-3 hours and 3-6 hours from onset. 42% of patients who received a transfusion had a serious adverse event, while only 29% of the standard management group did. Ultimately, the authors’ findings show worse outcomes associated with platelet transfusion in spontaneous hemorrhagic stroke patients on antiplatelet therapy, and as such this widely used intervention cannot be recommended.