Platelet transfusion is not associated with increased mortality or morbidity in patients undergoing cardiac surgery

Ninkovic, Slavisa; McQuilten, Zoe; Gotmaker, Robert; Newcomb, Andrew; Cole‐Sinclair, Merrole

doi:10.1111/trf.14561

Cited by 17 publications

(22 citation statements)

References 25 publications

(61 reference statements)

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“…The risk prediction tool was applied to a validation data set and demonstrated that a cardiac surgery patientʼs risk of receiving a PLT transfusion can be estimated preoperatively. Similarly to Ninkovic et al, 14 we found that patients who received PLT transfusion were more likely to have a diagnosis of infective endocarditis, recent myocardial infarction and recent exposure to aspirin or clopidogrel and less likely to have diabetes. We also found that patients receiving PLT transfusion were more likely to be older than 70 years, where Ninkovic et al 14 found that patients older than 80 years were more likely to receive PLT transfusions.…”

Section: Discussionsupporting

confidence: 84%

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Preoperative identification of cardiac surgery patients at risk of receiving a platelet transfusion: The Australian Cardiac Surgery Platelet Transfusion (ACSePT) risk prediction tool

et al. 2020

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Background Platelet (PLT) transfusions are limited and costly resources. Accurately predicting clinical demand while limiting product wastage remains difficult. A PLT transfusion prediction score was developed for use in cardiac surgery patients who commonly require PLT transfusions. Study Design and Methods Using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database, significant predictors for PLT transfusion were identified by multivariate logistic regression. Using a development data set containing 2005 to 2016 data, the Australian Cardiac Surgery Platelet Transfusion (ACSePT) risk prediction tool was developed by assigning weights to each significant predictor that corresponded to a probability of PLT transfusion. The predicted probability for each score was compared to actual PLT transfusion occurrence in a validation (2017) data set. Results The development data set contained 38 independent variables and 91 521 observations. The validation data set contained 12 529 observations. The optimal model contained 23 variables significant at P < .001 and an area under the receiver operating characteristic (ROC) curve of 0.69 (95% confidence interval [CI], 0.68‐0.69). ACSePT contained nine variables and had an area under the ROC curve of 0.66 (95% CI, 0.65‐0.66) and overall predicted probability of PLT transfusion of 19.8% for the validation data set compared to an observed risk of 20.3%. Conclusion The ACSePT risk prediction tool is the first scoring system to predict a cardiac surgery patientʼs risk of receiving a PLT transfusion. It can be used to identify patients at higher risk of receiving PLT transfusions for inclusion in clinical trials and by PLT inventory managers to predict PLT demand.

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Section: Discussionsupporting

confidence: 84%

“…One single-institution retrospective study has compared patient and surgical characteristics between those who received PLT transfusion. 14 No multi-institution study has reported predictors of PLT transfusion.…”

Section: Discussionmentioning

confidence: 99%

Preoperative identification of cardiac surgery patients at risk of receiving a platelet transfusion: The Australian Cardiac Surgery Platelet Transfusion (ACSePT) risk prediction tool

et al. 2020

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“…There were no confounders adjusted for in these studies. Other published studies have also examined the association between PLT transfusion and death in subgroups of critically ill patients including cardiac surgery, noncardiac surgery, liver transplantation, and medical patients . While conclusions from these studies also vary, a number of them have associated PLT transfusion with increased mortality in the nontransplant setting .…”

Section: Discussionmentioning

confidence: 99%

“…Results of studies examining the effect of PLT transfusions on mortality have been conflicting . Randomized trials in this area are lacking but observational studies have reported that PLT transfusions have neutral, beneficial, or harmful associations with the risk of death in noncancer patients with thrombocytopenia. These data are prone to confounding due to their observational nature and the complexity of critical illness, making adequate statistical methods essential yet challenging.…”

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confidence: 99%

The association between platelet transfusions and mortality in patients with critical illness

et al. 2019

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BACKGROUND: Platelet (PLT) transfusions are frequently administered in the setting of critical illness but their clinical impacts remain unknown. This study examined the association between PLT transfusions and death in a large intensive care unit (ICU) patient population. STUDY DESIGN AND METHODS: Using a transfusionregistry spanning 2008 to 2015, this study assessed effect of in-ICU PLT transfusions on ICU and in-hospital mortality using a stratified, time-dependent Cox proportional hazards model adjusted for illness severity, thrombocytopenia, and other confounders. Patients with known malignancy were excluded. Exposure to PLT transfusions were analyzed dichotomously (ever or never transfused) and continuously (number of transfusions). Medical, general surgery, and cardiac surgery subgroups were analyzed separately. RESULTS:Overall 32,842 adult patients were admitted to ICU, and 4927 patients received PLT transfusion(s). Crude in-ICU and in-hospital mortality were higher for PLT-transfused patients compared to nontransfused patients (9.2% vs. 6.7% and 12.3% vs. 9.3%, respectively). After confounders were adjusted for, PLT transfusions (ever vs. never) were not associated with increased mortality in ICU (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.60-1.02; p = 0.06) or in hospital (HR, 0.89; 95% CI, 0.68-1.09; p = 0.41). Continuous exposure analysis also showed no association between PLT transfusions and death. PLT transfusions have a protective effect on in-hospital mortality in the subgroup of general surgery patients (HR, 0.71; 95% CI, 0.51-0.99; p = 0.04; ever or never analysis). CONCLUSION:Platelet transfusions were not associated with increased risk of death in critically ill patients. Further studies are required to identify subgroups for which PLT transfusions may be beneficial.ABBREVIATIONS: HR = hazard ratio; ICU = intensive care unit; IQR(s) = interquartile range(s); MODS(s) = multiorgan dysfunction score(s). From the RESULTS Patient demographicsBetween 2008 and 2015, a total of 32,842 nononcology adult patients were admitted to one of three participating ICUs (Fig. 1). Median (IQR) age at admission was 66 (54-76) years and 11,944 (36.5%) of patients were female. Median (IQR) duration of ICU stay was 2 (1-4) days. Thrombocytopenia Volume 59, June 2019 TRANSFUSION 1963 PLT TRANSFUSION AND DEATH IN THE ICU * Data are reported as number (%) or median (IQR). † Cardiac surgery with cardiopulmonary bypass. ‡ Bleeding disorders include qualitative PLT defects, von Willebrand's disease, acquired factor deficiencies. § Mechanical ventilation may either be invasive or noninvasive. k MODS = multiple organ dysfunction score at baseline (range, 0-20). MODS were available for 29,550 (90.0%) of the overall patient population.

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“…In fact, other studies have failed to identify the same issue in patients undergoing cardiac surgery. Ninkovic and coworkers found that after confounders were adjusted for, PLT transfusion was not associated with an increased risk of 30‐day mortality or infective complications. PLT transfusion was associated with higher rates of return to the operating room, and interestingly, a decreased risk of thromboembolic events.…”

Section: Possible Hazards Transfusing Activated Pltsmentioning

confidence: 99%

Future of platelet formulations with improved clotting profile: a short review on human safety and efficacy data

Cancelas

2019

Transfusion

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BACKGROUND Platelet (PLT) transfusion is a widely used therapy in treating or preventing bleeding and hemorrhage in patients with thrombocytopenia or trauma. Compared to the relative ease of PLT transfusion, current practice for PLT storage at room temperature (RT) for up to 5 to 7 days is inefficient, costly, wasteful, and relatively unsafe. STUDY DESIGN AND METHODS This study was a review of major advances in PLT derivative products with improved hemostatic potential and safety feature. RESULTS Recent progress in understanding the PLT activation and host clearance mechanisms has led to reassessments of current and new storage conditions that employ refrigeration and/or cryopreservation to overcome storage lesions and significantly extend shelf life of PLTs with reduced risk of pathogen contamination. DISCUSSION It is anticipated that future PLT preservation involving cold, frozen, and/or pathogen reduction strategies in proper PLT additive solutions will enable longer term and safer PLT storage.

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Platelet transfusion is not associated with increased mortality or morbidity in patients undergoing cardiac surgery

Abstract: Platelet transfusion was not associated with increased mortality or infective complications following first cardiac surgery. Further prospective studies are required to identify patients most likely to benefit from platelet transfusion.

Cited by 17 publications

References 25 publications

Preoperative identification of cardiac surgery patients at risk of receiving a platelet transfusion: The Australian Cardiac Surgery Platelet Transfusion (ACSePT) risk prediction tool

Preoperative identification of cardiac surgery patients at risk of receiving a platelet transfusion: The Australian Cardiac Surgery Platelet Transfusion (ACSePT) risk prediction tool

The association between platelet transfusions and mortality in patients with critical illness

Future of platelet formulations with improved clotting profile: a short review on human safety and efficacy data

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