Prophylactic platelet transfusions prior to surgery for people with a low platelet count

Estcourt, Lise J; Malouf, Reem; Dorée, Carolyn; Trivella, Marialena; Hopewell, Sally; Birchall, Janet

doi:10.1002/14651858.cd012779.pub2

Cited by 28 publications

(33 citation statements)

References 79 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…fever or infection) (Webert, Cook, Sigouin, Rebulla, & Heddle, ). Our findings were similar to a recent Cochrane review that found insufficient evidence to recommend prophylactic platelet transfusion and no evidence that transfusion resulted in a reduction in POB for minor surgical procedures (Estcourt et al., ).…”

Section: Discussionsupporting

confidence: 90%

World Workshop on Oral Medicine VII: Platelet count and platelet transfusion for invasive dental procedures in thrombocytopenic patients: A systematic review

et al. 2019

View full text Add to dashboard Cite

Objectives To evaluate the evidence for a 50,000/μl platelet count threshold for platelet transfusion for invasive dental procedures in thrombocytopenic patients. Subjects and Methods We searched in MEDLINE/PubMed, EMBASE, the Cochrane Library (Wiley) and Scopus from 1960 through April 2018 for studies on patients with quantitative platelet disorders not related to medical co‐morbidities or medications and undergoing invasive dental procedures. Two reviewers conducted assessments independently. Results We found a total of 176 non‐duplicate articles, of which 9 cohort studies met our inclusion criteria. The incidence of postoperative bleeding in thrombocytopenic patients was low (4.9%), and we found no difference in bleeding incidence between patients who had platelet transfusion and those who did not. There was no difference in the mean platelet count for patients with and without bleeding. Different modalities are now available to prevent and control bleeding, which may reduce the need for platelet transfusion. Conclusions There is no evidence to support the long‐standing dogma of a need for a platelet count ≥ 50,000/μl for safe invasive dental procedures. Platelet transfusion effectiveness for haemostasis support could not be determined based on available data. Local measures and antifibrinolytics are the mainstay for the prevention and management of bleeding.

show abstract

Section: Discussionsupporting

confidence: 90%

World Workshop on Oral Medicine VII: Platelet count and platelet transfusion for invasive dental procedures in thrombocytopenic patients: A systematic review

et al. 2019

View full text Add to dashboard Cite

show abstract

“…A Cochrane systematic review identified two studies that assessed the use of platelet transfusions in patients undergoing minor procedures (►Table 5). 77 The first study compared the use of platelet transfusions or plasma transfusions or both to desmopressin in adults with chronic liver disease undergoing dental extraction. 78 There was no evidence of a difference in minor or major bleeding; however, the study only included 36 participants in the analysis.…”

Section: Other Surgery or Procedures With A Lower Risk Of Bleedingmentioning

confidence: 99%

Thrombocytopenia in Surgery and Neuraxial Anesthesia

Estcourt

2020

Semin Thromb Hemost

View full text Add to dashboard Cite

This is a review of the evidence for the use of different platelet count thresholds prior to invasive procedures and surgery. This review will focus on three procedures that are common in patients with thrombocytopenia—central venous catheter insertion, liver biopsy, and lumbar punctures and epidural catheters—as well as highlighting the lack of evidence for more major surgery. Tunneled or untunneled central venous catheters are low-risk procedures and can be safely performed without any intervention when the platelet count is 20 × 109/L or above. Evidence for their safety is more limited below this threshold, but as bleeding is easily treated, interventions should focus on treating any bleeding that occurs rather than preventative strategies. The available evidence for neuraxial anesthesia is based on very low-quality evidence from observational studies. Based on this evidence, the risk of an epidural hematoma is less than 0.19% (upper limit of 95% confidence interval) for pregnant women undergoing an epidural anesthetic when the platelet count is between 70 and 99 × 109/L. No randomized trials have been performed in children, nor have any randomized trials been performed in major or emergency surgeries.

show abstract

“…To prevent excess bleeding, guidelines recommend platelet transfusions prior to surgery for patients with counts <50 × 10 9 /L . Avatrombopag and lusutrombopag work to increase platelets, and it is therefore unsurprising that administering these drugs led to fewer transfusions.…”

Section: Avatrombopag and Lusutrombopagmentioning

confidence: 99%

A method to determine if more than surrogate outcomes were improved: The EMR glitch experiment

Gill

Prasad

2020

Research and Practice in Thrombosis and Haemostasis

View full text Add to dashboard Cite

Prophylactic platelet transfusions prior to surgery for people with a low platelet count

Cited by 28 publications

References 79 publications

World Workshop on Oral Medicine VII: Platelet count and platelet transfusion for invasive dental procedures in thrombocytopenic patients: A systematic review

World Workshop on Oral Medicine VII: Platelet count and platelet transfusion for invasive dental procedures in thrombocytopenic patients: A systematic review

Thrombocytopenia in Surgery and Neuraxial Anesthesia

A method to determine if more than surrogate outcomes were improved: The EMR glitch experiment

Contact Info

Product

Resources

About