Platelet transfusions improve hemostasis and survival in a substudy of the prospective, randomized PROPPR trial

Cardenas, Jessica C.; Xu, Zhihui; Fox, Erin E.; Cotton, Bryan A.; Hess, John R.; Schreiber, Martin A.; Wade, Charles E.; Holcomb, John B.

doi:10.1182/bloodadvances.2018017699

Cited by 117 publications

(104 citation statements)

References 39 publications

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“…Guidelines for platelet transfusion thresholds have been published but reducing plasma and platelet transfusion through blood management programs might be more difficult than reducing RBC transfusions . Platelet trends might also be affected by evidence supporting and guidelines recommending early platelet transfusion and a high ratio of platelets to RBCs during resuscitation of severely injured bleeding patients, potentially requiring hospitals to maintain increased numbers of platelets in inventory …”

Section: Discussionmentioning

confidence: 99%

“…34 Platelet trends might also be affected by evidence supporting and guidelines recommending early platelet transfusion and a high ratio of platelets to RBCs during resuscitation of severely injured bleeding patients, potentially requiring hospitals to maintain increased numbers of platelets in inventory. [35][36][37] Projections of RBC use in the United States from 2017 to 2022 suggest a continued 10.0% to 14.3% decline. Many industrialized countries have also reported recent declines in RBC use.…”

Section: Discussionmentioning

confidence: 99%

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Slowing decline in blood collection and transfusion in the United States – 2017

et al. 2020

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INTRODUCTION The National Blood Collection and Utilization Survey (NBCUS) has demonstrated declines in blood collection and transfusion in the United States since 2008, including declines of 11.6% in red blood cell (RBC) collections and 13.9% in RBC transfusions during 2013‐2015. This study described the 2017 NBCUS results. METHODS The 2017 NBCUS was distributed to all US blood collection centers, all hospitals performing at least 1000 surgeries annually, and a 40% random sample of hospitals performing 100 to 999 surgeries annually. Weighting and imputation were used to generate national estimates for units of blood and components collected, deferred, distributed, transfused, and outdated. RESULTS Response rates for the 2017 NBCUS were 88% for blood collection centers and 86% for transfusing hospitals. Compared with 2015, the number of RBC units collected during 2017 (12,211,000; 95% confidence interval [CI], 11,680,000‐12,742,000) declined by 3.0%, and transfused RBC units (10,654,000, 95% CI, 10,314,000‐10,995,000) declined by 6.1%. Distributed platelet (PLT) units (2,560,000; 95% CI, 2,391,000‐2,730,000 units) increased by 5.1%, and transfused PLT units (1,937,000, 95% CI, 1,794,000‐2,079,000) declined by 2.3%. Distributed plasma units (3,209,000; 95% CI, 2,879,000‐3,539,000) declined by 13.6%, and transfused plasma units (2,374,000; 95% CI, 2,262,000‐2,487,000) declined by 12.9%. CONCLUSION The 2017 NBCUS suggests a continued but slowing decline in demand for RBCs. The decline in blood collection and use will likely continue. Despite decreasing demand and increasing manufacturing costs of blood products, the US blood industry has met the regular and emergent needs of the country.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Slowing decline in blood collection and transfusion in the United States – 2017

et al. 2020

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“…In fact, among general surgery patients, there appears to be an association between improved in‐hospital mortality and PLT transfusion when PLT transfusions were analyzed dichotomously. A recently published substudy of the PROPPR (Pragmatic, Randomized Optimal Platelet and Plasma Ratios) randomized trial found that early PLT administration was associated with improved hemostasis, fewer deaths due to exsanguination, and improved 24‐hour and 30‐day mortality in patients with trauma . Given the important hemostatic functions of PLTs, it is certainly plausible that PLT transfusions may provide mortality benefit in specific subgroups of actively bleeding patients.…”

Section: Discussionmentioning

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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“…Data from many centers also supported the use of platelets as part of damage control resuscitation. [5][6][7][8][9] These compelling studies, which were supported by randomized clinical trial data, 10 led many centers to develop massive transfusion protocols (MTPs) that facilitated the timely delivery of a balanced complement of blood products to patients at bedside.…”

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confidence: 99%