Quality of evidence‐based guidelines for platelet transfusion and use: A systematic review

Al‐Riyami, Arwa Z.; Jug, Rachel; Rocca, Ursula La; Keshavarz, Homa; Landry, Denise; Shehata, Nadine; Stanworth, Simon; Nahirniak, Susan

doi:10.1111/trf.16257

Cited by 11 publications

(6 citation statements)

References 37 publications

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“…A systematic review of evidence-based clinical practice guidelines pertaining to platelet transfusions identified seven recent studies of variable quality 273 . Considering the inconsistencies between guidelines and the fact that none of them included recommendations for IPDs, no statement can be made regarding the indication of platelet transfusion in patients with IBDs.…”

Section: Discussionmentioning

confidence: 99%

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

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BACKGROUND Management of peri-operative bleeding is complex and involves multiple assessment tools and strategies to ensure optimal patient care with the goal of reducing morbidity and mortality. These updated guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) aim to provide an evidence-based set of recommendations for healthcare professionals to help ensure improved clinical management. DESIGN A systematic literature search from 2015 to 2021 of several electronic databases was performed without language restrictions. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assess the methodological quality of the included studies and to formulate recommendations. A Delphi methodology was used to prepare a clinical practice guideline. RESULTS These searches identified 137 999 articles. All articles were assessed, and the existing 2017 guidelines were revised to incorporate new evidence. Sixteen recommendations derived from the systematic literature search, and four clinical guidances retained from previous ESAIC guidelines were formulated. Using the Delphi process on 253 sentences of guidance, strong consensus (>90% agreement) was achieved in 97% and consensus (75 to 90% agreement) in 3%. DISCUSSION Peri-operative bleeding management encompasses the patient's journey from the pre-operative state through the postoperative period. Along this journey, many features of the patient's pre-operative coagulation status, underlying comorbidities, general health and the procedures that they are undergoing need to be taken into account. Due to the many important aspects in peri-operative nontrauma bleeding management, guidance as to how best approach and treat each individual patient are key. Understanding which therapeutic approaches are most valuable at each timepoint can only enhance patient care, ensuring the best outcomes by reducing blood loss and, therefore, overall morbidity and mortality. CONCLUSION All healthcare professionals involved in the management of patients at risk for surgical bleeding should be aware of the current therapeutic options and approaches that are available to them. These guidelines aim to provide specific guidance for bleeding management in a variety of clinical situations.

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Section: Discussionmentioning

confidence: 99%

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

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“…Of the 110 included SRs, 11 were SRs embedded in evidence‐based guideline projects [ 9 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ], and three were overviews of reviews concerning the management of traumatic brain injury [ 27 , 28 ] or trauma‐induced coagulopathy [ 29 ]. The remainder were SRs of primary research, either experimental studies, observational studies or both.…”

Section: Resultsmentioning

confidence: 99%

Systematic reviews on platelet transfusions: Is there unnecessary duplication of effort? A scoping review

et al. 2022

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Background and Objectives: Platelet transfusions are used across multiple patient populations to prevent and correct bleeding. This scoping review aimed to map the currently available systematic reviews (SRs) and evidence-based guidelines in the field of platelet transfusion. Materials and Methods:A systematic literature search was conducted in seven databases for SRs on effectiveness (including dose and timing, transfusion trigger and ratio to other blood products), production modalities and decision support related to platelet transfusion. The following data were charted: methodological features of the SR, population, concept and context features, outcomes reported, study design and number of studies included. Results were synthesized in interactive evidence maps. Results:We identified 110 SRs. The majority focused on clinical effectiveness, including prophylactic or therapeutic transfusions compared to no platelet transfusion (34 SRs), prophylactic compared to therapeutic-only transfusion (8 SRs), dose, timing (11 SRs) and threshold for platelet transfusion (15 SRs) and the ratio of platelet transfusion to other blood products in massive transfusion (14 SRs). Furthermore, we included 34 SRs on decision support, of which 26 evaluated viscoelastic testing. Finally, we identified 22 SRs on platelet production modalities, including derivation (4 SRs), pathogen inactivation (6 SRs), leucodepletion (4 SRs) and ABO/human leucocyte antigen matching (5 SRs). The SRs were mapped according to concept and clinical context. Conclusion:An interactive evidence map of SRs and evidence-based guidelines in the field of platelet transfusion has been developed and identified multiple reviews.This work serves as a tool for researchers looking for evidence gaps, thereby both supporting research and avoiding unnecessary duplication.

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“…[13][14][15] Although clinical practice guidelines recommend prophylactic platelet transfusions, 3 the evidence supporting platelet transfusions in specific clinical indications has been rated as low/verylow quality by GRADE methodology and there are inconsistent recommendations across various guidelines. 16,17 Although Patient Blood Management (PBM) initiatives appear to be effective in restricting RBC and plasma transfusions nationwide, targeted interventions are needed for platelets.…”

Section: Resultsmentioning

confidence: 99%

Blood transfusion trends in the United States: national inpatient sample, 2015 to 2018

et al. 2021

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Blood transfusions are among the most common therapeutic procedures performed in hospitalized patients. This study evaluates contemporary national trends in RBC, plasma, platelet and cryoprecipitate transfusions. National Inpatient Sample (NIS), the largest all-payer inpatient database representing 94-97% of US population, was evaluated from the 4th quarter of 2015 through 2018. Quarterly trends for the percentage of hospitalizations with a transfusion procedure were separately examined for each blood product using log binomial regression and reported as quarterly percent change (QPC). The percentage of hospitalizations with a RBC transfusion decreased from 4.22% (2015Q4) to 3.79% (2018Q4) (QPC=-0.72[95%CI=-1.26, -0.19]; Ptrend=0.008). While plasma transfusions also decreased QPC=-1.33(95%CI=-2.00, 0.65;Ptrend<0.001), platelet transfusions remained stable QPC=-0.13[95%CI=-0.99,0.73]; Ptrend=0.766). In contrast, hospitalizations with cryoprecipitate utilization significantly increased QPC=2.01(95%CI=0.57,3.44; Ptrend=0.006). Significant quarterly reductions in RBC transfusions were also seen among many -but not all- strata of sex, race/ethnicity, patient risk-severity, and admission type (elective versus non-elective). Despite significant declines in RBC transfusions among older adults, there were no significant changes among pediatric age-group (<18-years) and those 18-49 years. The decline in RBC and plasma transfusions suggests steady incorporation of robust evidence base showing safety of restrictive transfusions. Increased cryoprecipitate use may be reflective of wider adoption of hypofibrinogenemia management and hemostasis testing for coagulopathic patients.

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Quality of evidence‐based guidelines for platelet transfusion and use: A systematic review

Cited by 11 publications

References 37 publications

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Systematic reviews on platelet transfusions: Is there unnecessary duplication of effort? A scoping review

Blood transfusion trends in the United States: national inpatient sample, 2015 to 2018

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