Prophylactic use of platelets in critically ill patients with thrombocytopaenia: A retrospective two-centre observational study

O'Bryan, Liam J.; Bedford, Jonathan; Redfern, Oliver; Hatch, Robert Alan; Young, J D; Watkinson, Peter

doi:10.1016/j.jcrc.2020.03.003

Cited by 8 publications

(5 citation statements)

References 19 publications

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“…[9][10][11] Previous studies reporting data on the use of platelet transfusions in adult ICU patients have primarily focused on indications for platelet transfusions, pre-transfusion platelet counts and post-transfusion platelet count increments. 3,8,[12][13][14][15][16][17][18] Some studies have reported data from general ICU patients, 8,[12][13][14]17 but few have been international. 13 Data describing other important aspects of the epidemiology of platelet transfusions, such as the type of platelet product used (apheresisderived versus pooled whole-blood-derived), platelet transfusion volumes, method of dosing and the timing of transfusion during ICU stay, are scarce.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies reporting data on the use of platelet transfusions in adult ICU patients have primarily focused on indications for platelet transfusions, pre‐transfusion platelet counts and post‐transfusion platelet count increments 3,8,12–18 . Some studies have reported data from general ICU patients, 8,12–14,17 but few have been international 13 .…”

Section: Introductionmentioning

confidence: 99%

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Platelet transfusions in adult thrombocytopenic ICU patients: Protocol for a sub‐study of the PLOT‐ICU cohort

Anthon,

Pène,

Perner

et al. 2023

Acta Anaesthesiol Scand

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IntroductionPlatelet transfusions are frequently used in intensive care unit (ICU) patients, but contemporary epidemiological data are sparse. We aim to present contemporary international data on the use of platelet transfusions in adult ICU patients with thrombocytopenia.MethodsThis is a protocol and statistical analysis plan for a post hoc sub‐study of 504 thrombocytopenic patients from the ‘Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT‐ICU)’. The primary outcome will be the number of patients receiving platelet transfusion in the ICU reported according to the type of product received (apheresis‐derived versus pooled whole‐blood‐derived transfusions). Secondary platelet transfusion outcomes will include platelet transfusion volumes; timing of platelet transfusion; approach to platelet transfusion dosing (fixed dosing versus weight‐based dosing) and platelet count increments for prophylactic transfusions. Secondary clinical outcomes will include the number of patients receiving red blood cell‐ and plasma transfusions during ICU stay; the number of patients who bled in the ICU, the number of patients who had a new thrombosis in the ICU, and the number of patients who died. The duration of follow‐up was 90 days. Baseline characteristics and secondary clinical outcomes will be stratified according to platelet transfusion status in the ICU and severity of thrombocytopenia. Data will be presented descriptively.ConclusionsThe outlined study will provide detailed epidemiological data on the use of platelet transfusions in adult ICU patients with thrombocytopenia using data from the large international PLOT‐ICU cohort study. The findings will inform the design of future randomised trials evaluating platelet transfusions in ICU patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Platelet transfusions in adult thrombocytopenic ICU patients: Protocol for a sub‐study of the PLOT‐ICU cohort

Anthon,

Pène,

Perner

et al. 2023

Acta Anaesthesiol Scand

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“…Apart from expert opinion and several single-center retrospective studies, no data exist on key clinical outcomes including bleeding, days spent in the hospital, and death (5,6). Meanwhile, the benefits of platelet transfusion in sepsis patients with thrombocytopenia have been questioned (7,8). Additionally, several studies suggested that platelet transfusion is associated with adverse effects including acute myocardial infarction, infection, stroke, thrombosis, and lung injury (9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Platelet Transfusion in Patients With Sepsis and Thrombocytopenia: A Propensity Score-Matched Analysis Using a Large ICU Database

Fan

et al. 2022

Front. Med.

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PurposeSepsis with thrombocytopenia is highly prevalent in critically ill intensive care unit (ICU) patients and is associated with adverse outcomes. Platelet transfusion is the primary treatment of choice. However, evidence for the beneficial effects of platelet transfusion in patients with sepsis and thrombocytopenia is scarce and low in quality. This study aimed to evaluate the association between platelet transfusion and mortality among ICU patients with sepsis and thrombocytopenia.Patients and MethodsUsing the Medical Information Mart for Intensive Care III database (v. 1.4), the outcomes of sepsis patients with platelet counts of ≤ 150,000/μL were compared between those who did and did not receive platelet transfusion. The primary outcomes were 28- and 90-day all-cause mortalities. The secondary outcomes were red blood cell (RBC) transfusion, ICU-free days, and hospital-free days. Propensity score matching was employed to assemble a cohort of patients with similar baseline characteristics.ResultsAmong 7,765 eligible patients, 677 received platelet transfusion and were matched with 677 patients who did not receive platelet transfusion according to propensity scores. Platelet transfusion, as compared with no platelet transfusion, was associated with an increased risk of 28-day all-cause mortality [36.9 vs. 30.4%, odds ratio (OR), 1.21; 95% confidence interval (CI), 1.01–1.46; p = 0.039], increased risk of 90-day all-cause mortality (50.8 vs. 44.6%, OR, 1.13; 95% CI, 1.00–1.31; p = 0.048), fewer mean (standard deviation) 28-day ICU-free days (15.88 ± 8.97 vs. 18.64 ± 8.33 days, p < 0.001), and fewer hospital-free days (10.29 ± 8.49 vs. 11.43 ± 8.85 days, p = 0.017). The rate of RBC transfusion was not significantly different between the platelet transfusion and non-transfusion groups (p = 0.149). The results were maintained across several subgroup and sensitivity analyses.ConclusionIn this study, platelet transfusion was associated with higher 28- and 90-day all-cause mortalities. These results suggest the potential hazards of platelet transfusion in ICU patients with sepsis and thrombocytopenia.

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“…17,18 The benefits of platelet transfusion and the effect of platelet transfusion on mortality in patients with different degrees of thrombocytopenia are still controversial. 19,20 Consequently, we wished to answer those questions to some extent.…”

Section: Introductionmentioning

confidence: 99%

Thrombocytopenia in 737 adult intensive care unit patients: A real-world study of associated factors, drugs, platelet transfusion, and clinical outcome

Zhang

et al. 2020

SAGE Open Medicine

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Objective: We aimed to identify and represent factors associated with thrombocytopenia in intensive care unit, especially the pathogens and drugs related to severe and extremely thrombocytopenia. Then, we aim to compare the mortality of platelet transfusion and non-transfusion in patients with different degrees of thrombocytopenia. Methods: We identified all thrombocytopenic patients in intensive care unit by using platelet-specific values and then extracted electronic health records from our Hospital Information System. Data were statistically analyzed with t test, chi-square test, and logistic regression. Results: We found that infections (32.7%) were the most frequent cause associated with thrombocytopenia, followed by sepsis shock (3.93%) and blood loss (2.99%). Meanwhile, antifungals ( p = 0.002) and bacterial infection ( p = 0.037) were associated with severe and extremely severe thrombocytopenia. Finally, we found that the mortality of platelet transfusion and non-transfusion in patients was statistically significant for patients with platelet counts between 30 and 49/nL (χ2 = 9.719, p = 0.002). Conclusion: Infection and sepsis emerged as two primary factors associated with thrombocytopenia in intensive care unit. Meanwhile, antifungals and bacterial infection were associated with platelet counts less than 49/nL. Finally, platelet transfusion may be associated with reduced mortality in patients with platelet counts between 30 and 49/nL.

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Prophylactic use of platelets in critically ill patients with thrombocytopaenia: A retrospective two-centre observational study

Cited by 8 publications

References 19 publications

Platelet transfusions in adult thrombocytopenic ICU patients: Protocol for a sub‐study of the PLOT‐ICU cohort

Platelet transfusions in adult thrombocytopenic ICU patients: Protocol for a sub‐study of the PLOT‐ICU cohort

Platelet Transfusion in Patients With Sepsis and Thrombocytopenia: A Propensity Score-Matched Analysis Using a Large ICU Database

Thrombocytopenia in 737 adult intensive care unit patients: A real-world study of associated factors, drugs, platelet transfusion, and clinical outcome

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