Alternative agents to prophylactic platelet transfusion for preventing bleeding in people with thrombocytopenia due to chronic bone marrow failure: a meta-analysis and systematic review

Desborough, Michael J R; Hadjinicolaou, Andreas V.; Chaimani, Anna; Trivella, Marialena; Vyas, Paresh; Doree, Carolyn; Hopewell, Sally; Stanworth, Simon J.; Estcourt, Lise J

doi:10.1002/14651858.cd012055.pub2

Cited by 13 publications

(330 citation statements)

References 118 publications

(330 reference statements)

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“…First, only 16 RCTs were included, reflecting the paucity of high‐quality studies available in the CHR‐P field. However, capitalizing on the increased power and precision of NMA, the Cochrane group has conducted such analysis in even smaller databases, including as few as three to seven studies. Furthermore, sufficient data were available for 6 and 12 month networks only, which precluded insight into whether treatments may have some effectiveness in the longer term.…”

Section: Discussionmentioning

confidence: 99%

Lack of evidence to favor specific preventive interventions in psychosis: a network meta-analysis

Davies

Cipriani

Ioannidis³

et al. 2018

World Psychiatry

153

148

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Preventing psychosis in patients at clinical high risk may be a promising avenue for pre-emptively ameliorating outcomes of the most severe psychiatric disorder. However, information on how each preventive intervention fares against other currently available treatment options remains unavailable. The aim of the current study was to quantify the consistency and magnitude of effects of specific preventive interventions for psychosis, comparing different treatments in a network meta-analysis. PsycINFO, Web of Science, Cochrane Central Register of Controlled Trials, and unpublished/grey literature were searched up to July 18, 2017, to identify randomized controlled trials conducted in individuals at clinical high risk for psychosis, comparing different types of intervention and reporting transition to psychosis. Two reviewers independently extracted data. Data were synthesized using network meta-analyses. The primary outcome was transition to psychosis at different time points and the secondary outcome was treatment acceptability (dropout due to any cause). Effect sizes were reported as odds ratios and 95% confidence intervals (CIs). Sixteen studies (2,035 patients, 57% male, mean age 20.1 years) reported on risk of transition. The treatments tested were needs-based interventions (NBI); omega-3 + NBI; ziprasidone + NBI; olanzapine + NBI; aripiprazole + NBI; integrated psychological interventions; family therapy + NBI; D-serine + NBI; cognitive behavioural therapy, French & Morrison protocol (CBT-F) + NBI; CBT-F + risperidone + NBI; and cognitive behavioural therapy, van der Gaag protocol (CBT-V) + CBT-F + NBI. The network meta-analysis showed no evidence of significantly superior efficacy of any one intervention over the others at 6 and 12 months (insufficient data were available after 12 months). Similarly, there was no evidence for intervention differences in acceptability at either time point. Tests for inconsistency were non-significant and sensitivity analyses controlling for different clustering of interventions and biases did not materially affect the interpretation of the results. In summary, this study indicates that, to date, there is no evidence that any specific intervention is particularly effective over the others in preventing transition to psychosis. Further experimental research is needed.

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Section: Discussionmentioning

confidence: 99%

Lack of evidence to favor specific preventive interventions in psychosis: a network meta-analysis

Davies

Cipriani

Ioannidis³

et al. 2018

World Psychiatry

153

148

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“…4,8,11 There is little evidence about the effectiveness of alternative treatments to platelet transfusions. 52 BSH guidelines recommend considering administration of tranexamic acid in trauma patients with severe bleeding and also in patients with chronic thrombocytopenia due to bone marrow failure in addition to platelet transfusion therapy. 11…”

Section: What Is the Best Platelet Transfusion Strategy: Prophylacticmentioning

confidence: 99%

<p>Platelet Transfusion: And Update on Challenges and Outcomes</p>

Alcaina

2020

JBM

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Platelet transfusion is a common practice in onco-hematologic patients for preventing or treating hemorrhages. Platelet concentrates can be transfused with therapeutic or prophylactic purposes. With the aim to help clinicians to take the decisions on platelet transfusion, some guidelines have been developed based on the current scientific evidence. However, there are some controversial issues and available scientific evidence is not enough to solve them. There is little information about what is the best platelet product to be transfused: random platelets or single donor apheresis platelets, and plasma-suspended or additive solution suspended platelets. Platelets are often transfused without respecting the ABO compatibility, but influence of this practice on platelet transfusion outcome is not well established. In the prophylactic platelet transfusion set there are some questions unsolved as the platelet threshold to transfuse prior to specific procedures or surgery, and even if platelet transfusion is necessary for some specific procedures as autologous hematopoietic stem cell transplantation. A challenging complication raised from multiple platelet transfusions is the platelet transfusion refractoriness. The study and management of this complication is often disappointing. In summary, although it is a widespread practice, platelet transfusion has still many controversial and unknown issues. The objective of this article is to review the current evidence on platelet transfusion practices, focusing on the controversial issues and challenges.

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“…Progression to acute myeloid leukaemia (AML) was more common in patients who received eltrombopag in combination with Aza compared to the Aza plus placebo group (12% vs. 6%, respectively), and only 16% of the patients who received Aza plus eltrombopag became platelet transfusion independent versus 31% in the Aza + placebo group. In 2016, a Cochrane review did not find enough evidence for recommending either romiplostim or eltrombopag for patients with MDS . To date, no specific mutations correlating with the effects of TPO receptor agonist therapy have been identified.…”

Section: Treatment Of Lower‐risk Mdsmentioning

confidence: 99%