Randomized Trial of Platelet-Transfusion Thresholds in Neonates

Curley, Anna; Sj, Stanworth; Willoughby, Karen A.; Sf, Fustolo-Gunnink; Venkatesh,; Hudson, Cara; Deary, Alison; Hodge, Renate; Hopkins, David; B, Lopez Santamaria; Mora, Ariana Franco; Llewelyn, Charlotte; D’Amore, Angela; Khan, Rizwan; Onland, Wes; Lopriore, Enrico; Fijnvandraat, Karin; H, New; Clarke, Paul; Watts, Troy

doi:10.1056/nejmoa1807320

Cited by 299 publications

(281 citation statements)

References 27 publications

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“…Based on the findings of the PlaNeT‐2 (Platelets for Neonatal Transfusion–Study 2) trial in which neonates (including 16% with NEC) randomized to a higher platelet transfusion threshold had a significantly higher rate of death or major bleeding, we recommend the use of restrictive platelet thresholds of 25 × 10/L for transfusion to patients with NEC. In addition, larger, well‐powered cohort studies are needed to better understand the role of PTX on relevant outcomes among infants with NEC, and particularly the link between donor platelet cytokines, storage time, and neonatal outcomes.…”

Section: Discussionmentioning

confidence: 99%

Platelet transfusions and mortality in necrotizing enterocolitis

et al. 2018

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BACKGROUND Prior studies have suggested an association between platelet transfusions (PTXs) and worse outcomes among infants with necrotizing enterocolitis (NEC), potentially mediated by proinflammatory factors released by platelets. However, the effects of storage on platelet proinflammatory factor release and the confounding role of illness severity on NEC outcomes have not been determined. STUDY DESIGN AND METHODS First, neuropeptide Y (a potent splanchnic vasoconstrictor released by platelets) was measured by enzyme‐linked immunosorbent assay in fresh frozen plasma and in the supernatant of leukoreduced apheresis‐derived platelets at different times during storage. Next, we evaluated the relationship between PTX rates and death in a multicenter cohort of very‐low‐birth‐weight infants with NEC, adjusting for illness severity. RESULTS Neuropeptide Y levels increased over time in the supernatant of leukoreduced apheresis‐derived platelets and were 4.4‐fold and 8.9‐fold higher than in fresh frozen plasma on Days 2 and 3 of storage, respectively (p < 0.001). Among 598 very‐low‐birth‐weight infants, 44 developed NEC. In unadjusted analysis, PTX rate was 30.3 (95% confidence interval [CI], 11.5–80.1) per 100 infant‐days among infants who died, compared to 6.0 (95% CI, 3.2–11.2) among survivors (incidence rate ratio, 5.1; 95% CI, 1.6–16.2; p = 0.006). In multivariable analysis, there was no association between PTX rate and mortality (incidence rate ratio, 3.0; 95% CI, 0.6–15.0; p = 0.18), although estimation was imprecise. CONCLUSION Proinflammatory mediators accumulate in platelet suspensions during storage. Although PTX rates were not associated with increased mortality among infants with NEC in our study, our estimates suggest the potential for such an association that needs evaluation in larger studies.

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Section: Discussionmentioning

confidence: 99%

Platelet transfusions and mortality in necrotizing enterocolitis

et al. 2018

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“…In another study that included 376 patients who received prophylactic PCs prior to an invasive procedure (majority for platelet count <50 × 10 9 /L), platelet transfusion was associated with an increased risk of thrombosis and mortality compared to historical rates of thrombosis in cancer patients and the national in‐hospital mortality rate . In a randomized controlled trial of neonates, those transfused at a higher platelet threshold (50 × 10 9 /L) had a higher rate of bleeding and death compared to those transfused at the lower threshold (25 × 10 9 /L) . There are a number of reasons that transfusion of PCs may not be efficacious and could even be harmful.…”

Section: Discussionmentioning

confidence: 99%

Isolated platelet concentrate transfusion during surgery: a single‐center observational cohort study

et al. 2019

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BACKGROUND Surgical patients receive platelet concentrates (PCs) for a variety of indications. However, there is limited evidence for efficacy or dosing of PCs. STUDY DESIGN AND METHODS We performed a retrospective cohort study of surgical patients receiving isolated PC transfusion at a single academic tertiary medical center during 1 year. The primary outcome was reoperation for a bleeding complication. Bleeding complication rates were compared in patients transfused for different indications, and multivariable logistic regression was performed to determine variables associated with bleeding complications. RESULTS Approximately 1% of surgical patients (n = 205), including 7% of cardiac surgery patients, received an isolated PC transfusion. Cardiac surgery patients accounted for 47% of isolated PC transfusions, followed by neurosurgery (19%) and gastrointestinal surgery (13%). Most patients (81%) received a single apheresis unit of PC. Common indications were antiplatelet drugs (50%), thrombocytopenia (19%), congenital platelet disorders (2%), and both thrombocytopenia and antiplatelet drugs (12%). Bleeding complications occurred in 23% of patients, with the lowest bleeding complication rate observed in patients transfused for antiplatelet drugs (13%) and the highest rate in patients transfused for thrombocytopenia with or without antiplatelet drugs (40% and 38%, respectively). Bleeding complications were more common in noncardiac surgery but had no association with transfusion indication. CONCLUSION Despite transfusion for conventionally accepted indications, patients who received an isolated PC transfusion experienced a high rate of bleeding complications, particularly noncardiac surgery patients. Further studies are needed to establish optimal dosing, timing, and indications for perioperative PC transfusion.

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“…There is little consensus on the indications for platelet transfusions in neonates with thrombocytopenia. A multicentre European trial randomised infants <34 weeks' gestation at birth to receive platelet transfusions if their platelet count fell below either 50 000/mm 3 (high threshold) or 25 000/mm 3 (low threshold) . The primary outcome was death or new major bleeding within 28 days.…”

mentioning

confidence: 99%

“…The major effect was on mortality (15 vs. 10%). Platelet transfusions have been shown to be deleterious in adults with intracranial bleeding associated with anti‐platelet agents and in adults with platelet‐consumptive disorders, perhaps due to immune dysregulation . Platelet transfusions are potentially risky and should be used carefully on the basis of best available evidence.…”

mentioning

confidence: 99%

Platelet transfusions in neonates

2019

J Paediatrics Child Health

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Randomized Trial of Platelet-Transfusion Thresholds in Neonates

Cited by 299 publications

References 27 publications

Platelet transfusions and mortality in necrotizing enterocolitis

Platelet transfusions and mortality in necrotizing enterocolitis

Isolated platelet concentrate transfusion during surgery: a single‐center observational cohort study

Platelet transfusions in neonates

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