The current evidence suggests that Antiplatelet agents (APA) slightly increase the risk of death and disease progression in patients with traumatic (TBI) or spontaneous intracranial hemorrhage (ICH). Disappointingly there is little evidence that APA reversal with platelet transfusion (PLT) may improve the outcome. In this systematic review and meta-analysis, our goal was to evaluate the differences in mortality, severe disability, and hematoma expansion related to PLT transfusion. We retrieved randomized, or cohort studies comparing adult patients on APA with TBI or ICH who were treated with PLT or not. We calculated the standardized Risk Difference (RD) and 95% CI. A random-effects model was applied to analyze the data. The heterogeneity of the retrieved trials was evaluated through the I statistic. Our review finally included 16 clinical trials. We observed a significant difference between the two groups only for hematoma expansion: RD was -0.10 (10%; 95% CI: -0.14 to -0.05; P<0.0001; I=0.90) in favor of PLT transfusion. Performing subgroups analyses according to the type of bleeding mechanism, we observed the same results. The use of PLT in patients on APA affected by intracranial hemorrhage seemed to have no clear beneficial effect for the outcomes evaluated; conversely, PLT appeared to slightly increase the odds for adverse events of thromboembolic origin, even though not significantly.Copyright © 2020 Elsevier Inc. All rights reserved.