Dose of Prophylactic Platelet Transfusions and Prevention of Hemorrhage

Slichter, Sherrill J.; Kaufman, Richard M.; Assmann, Susan F.; McCullough, Jeffrey; Triulzi, Darrell J.; Strauss, Ronald G.; Gernsheimer, Terry; Ness, Paul M.; Brecher, Mark E.; Josephson, Cassandra D.; Konkle, Barbara A.; Woodson, Robert D.; Ortel, Thomas L.; Hillyer, Christopher D.; Skerrett, Donna; McCrae, Keith R.; Sloan, Steven R.; Uhl, Lynne; George, James N.; Aquino, Victor; Manno, Catherine S.; McFarland, Janice G.; Hess, John R.; Leissinger, Cindy; Granger, Suzanne

doi:10.1056/nejmoa0904084

Cited by 560 publications

(633 citation statements)

References 23 publications

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“…[5] The TOPPS was a randomized, open-label, non inferiority trial performed at 14 centers in the United Kingdom and Australia. Patients were randomly assigned to receive, or not to receive, prophylactic platelet transfusions when platelet counts were less than 10 9 10 9 /L [3,4]. Eligible patients were persons 16 years of age or older who were receiving chemotherapy or undergoing stem cell transplantation, and who had or were expected to have thrombocytopenia (platelet count \50 9 10 9 /L) for at least 5 days.…”

Section: Resultsmentioning

confidence: 99%

“…Platelet transfusions are usually administered as prophylaxis, to increase low platelet counts, and to reduce the risk of bleeding [1,2]. It has been shown that the threshold for prophylactic platelet transfusions can be reduced from the previous guideline of 20,000 platelets per cubic millimeter to 10,000 per cubic millimeter without increasing the risk [3]. Furthermore, a recent study [4] suggests that a policy of giving platelet transfusion only as treatment for bleeding can become a suitable choice in low-risk adult patients with hematological cancers, although the primary end point of the study was not a relevant outcome such as the reduction in the number of platelet transfusions.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Platelet transfusion strategy for hematologic cancers

Podda

Ricci

2014

Intern Emerg Med

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Platelet transfusion strategy for hematologic cancers

Podda

Ricci

2014

Intern Emerg Med

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“…Although there is some evidence for the effectiveness of prophylactic platelet transfusion in terms of threshold for bleeding and dose for hemostasis [72][73][74][75] these studies did not evaluate platelet transfusions before intervention but rather prophylactic platelet transfusions in leukemia patients when platelet count was < 10 × 10 9 /L.…”

Section: Discussionmentioning

confidence: 99%

Aspects of bleeding complications and hemostasis at central line insertion and mild induced hypothermia

Kander

2014

Acta Anaesthesiol Scand

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“…It is made more challenging by the presence of other complications of cancer therapy, such as thrombocytopenia, which is common among patients undergoing chemotherapy for hematologic malignancy and certain solid tumors. While thrombocytopenia has not shown any protective benefits against recurrent VTE among CAT patients, it has been associated with increased rates of bleeding 4. Therefore, the management of anticoagulation in this patient population requires special attention.…”

Section: Introductionmentioning

confidence: 99%

Management of anticoagulation for cancer‐associated thrombosis in patients with thrombocytopenia: A systematic review

Bannow

Lee

Khorana

et al. 2018

Research and Practice in Thrombosis and Haemostasis

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Essentials The management of anticoagulation in patients with thrombocytopenia is controversial.Some studies suggest to administer reduced‐dose low‐molecular‐weight heparin (LMWH).While other studies suggest full‐dose anticoagulation using LMWH and transfusion support.The results from our systematic review do not support one management strategy over another. BackgroundThe management of anticoagulation for cancer‐associated thrombosis (CAT) in patients with thrombocytopenia is controversial. Whereas some studies suggest that administration of reduced‐dose low‐molecular‐weight heparin (LMWH) or temporary discontinuation for moderate and severe thrombocytopenia may be a safe and effective, others suggest full‐dose anticoagulation with transfusion support. We sought to address this important knowledge gap and summarize the literature comparing these two common management strategies.MethodsA systematic review of the literature (PROSPERO CRD42017077127) using MEDLINE (inception to September 2017) was conducted. We included studies that reported recurrent venous thromboembolism (VTE) and major bleeding complications among patients treated with both of the two most common management strategies: therapeutic anticoagulation with platelet transfusion support and dose‐modified anticoagulation for periods when the platelet count is <50 × 109/L.ResultsA total of 134 article records were identified on the initial search and 10 articles underwent full text review. Two observational studies met the inclusions criteria. A total of 121 patients with CAT and thrombocytopenia were included. Forty‐two of these patients had pulmonary embolism and 87 had deep vein thrombosis (DVT) including 38 upper extremity DVT. Overall, 27% of patients, regardless of their treatment strategy, experienced recurrent VTE. Thirteen percent of anticoagulated patients (15% of all patients) experienced a major bleeding episode. Meta‐analysis could not be conducted.ConclusionsOur findings do not support one management strategy over another to treat CAT patients with thrombocytopenia. However, the data highlights the heightened risk of recurrent VTE in this patient population despite the thrombocytopenia.

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Dose of Prophylactic Platelet Transfusions and Prevention of Hemorrhage

Abstract: BACKGROUND-We conducted a trial of prophylactic platelet transfusions to evaluate the effect of platelet dose on bleeding in patients with hypoproliferative thrombocytopenia.

Cited by 560 publications

References 23 publications

Platelet transfusion strategy for hematologic cancers

Platelet transfusion strategy for hematologic cancers

Aspects of bleeding complications and hemostasis at central line insertion and mild induced hypothermia

Management of anticoagulation for cancer‐associated thrombosis in patients with thrombocytopenia: A systematic review

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