Liberal use of platelet transfusions in the acute phase of trauma resuscitation: a systematic review

Outcomes of patients receiving a massive transfusion for major trauma

“…Survivor bias, which has been raised frequently as a confounder in previous analyses of transfusion ratios, should be considered in the present study. As the time required to commence plasma and platelet transfusions is generally longer than that required to commence RBC transfusion, survivor bias is mainly of concern in patients who died shortly after arrival in the ED and consequently could not receive a sufficient dose of plasma or platelets in time; these patients were likely to have received relatively larger amounts of RBCs.…”

“…The three analyses were also performed in two different cohorts to minimize survivor bias, and to assess the difference in pathophysiology owing to injured region. First, considering the effects of patients who died before plasma or platelets could be administered (survivor bias), which has been mentioned in many earlier studies, analyses of patients who survived more than 24 h after ED arrival were performed. Second, considering the different pathophysiology in patients with traumatic brain injury (TBI), analyses were carried out that included only patients who did not present with accompanying TBI.…”

Transfusion strategies for major haemorrhage in trauma

“…However, to date, the effects of platelet transfusion remain unclear. For example, there are few observational studies that show benefit solely from platelet transfusion (Perkins et al, 2009;Inaba et al, 2010;Shaz et al, 2010) and, notably, all three of these studies suffered from significant survivorship bias (Hallet et al, 2013), whereas the two observational studies evaluating platelet effect that were deemed of higher quality, i.e. without survivor bias (Cotton et al, 2008;del Junco et al, 2013) were unable to show an overall mortality benefit.…”

Transfusion in Critically Ill Children

“…Alternatively, a definition of massive transfusion has been suggested if transfusion needs reach 80 mL/kg body weight of blood products over a 24-hour period. A recently published systematic review of publications reporting on the use of a high platelet:RBC transfusion regimen concluded that at this time, there were insufficient evidence to "strongly support" the routine use of high platelet:RBC ratio resuscitation regimens in trauma patients and that further randomized trials were needed to determine safety and efficacy of such approaches (171). The goal of this approach has been to prevent the development of a coagulopathy as a consequence of platelet and clotting factor depletion secondary to transfusion restricted to pRBCs.…”