What is the evidence for platelet transfusion in perioperative settings?

Levy, Jerrold H.; Rossaint, Rolf; Zacharowski, Kai; Spahn, Donat R.

doi:10.1111/vox.12576

Cited by 21 publications

(16 citation statements)

References 47 publications

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“…The efficacy of PLT transfusion in the perioperative setting in ICU patients and especially in trauma patients is controversial [1,25,26]. Moreover, supplying PLT concentrates is sometimes difficult for blood banks, and transfusion carries the risk of several serious side-effects.…”

Section: Discussionmentioning

confidence: 99%

Dynamics of Platelet Counts in Major Trauma: The Impact of Haemostatic Resuscitation and Effects of Platelet Transfusion—A Sub-Study of the Randomized Controlled RETIC Trial

Tauber

Innerhofer

Langen

et al. 2020

JCM

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Although platelets play a central role in haemostasis, the dynamics of platelet counts during haemostatic resuscitation, the response to platelet transfusion, and effects on clinical outcome are poorly described for trauma patients. As a sub-study of the already published randomized controlled RETIC Study “Reversal of Trauma-induced Coagulopathy using First-line Coagulation Factor Concentrates or Fresh-Frozen Plasma” trial, we here analysed whether the type of first-line haemostatic resuscitation influences the frequency of platelet transfusion and determined the effects of platelet transfusion in coagulopathic patients with major trauma. Patients randomly received first-line plasma (FFP) or coagulation factor concentrates (CFC), mainly fibrinogen concentrate. In both groups, platelets were transfused to maintain platelet counts between 50 and 100 × 109/L. Transfusion rates were significantly higher in the FFP (n = 44) vs. CFC (n = 50) group (FFP 47.7% vs. CFC 26%); p = 0.0335. Logistic regression analysis adjusted for the stratification variables injury severity score (ISS) and brain injury confirmed that first-line FFP therapy increases the odds for platelet transfusion (odds ratio (OR) 5.79 (1.89 to 20.62), p = 0.0036) and this effect was larger than a 16-point increase in ISS (OR 4.33 (2.17 to 9.74), p = 0.0001). In conclusion, early fibrinogen supplementation exerted a platelet-saving effect while platelet transfusions did not substantially improve platelet count and might contribute to poor clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Dynamics of Platelet Counts in Major Trauma: The Impact of Haemostatic Resuscitation and Effects of Platelet Transfusion—A Sub-Study of the Randomized Controlled RETIC Trial

Tauber

Innerhofer

Langen

et al. 2020

JCM

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“…1,6,7 Although a common intervention, there are reported variations in the rate of PLT transfusion in cardiac surgery patients between institutions. [8][9][10] Being able to predict PLT transfusion in cardiac surgery would be useful both to blood services and hospitals to better anticipate demand for PLTs. Furthermore, identifying cardiac surgery patients preoperatively who are likely to require PLT transfusion would facilitate undertaking clinical trials of PLT transfusion interventions.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac surgery patients are transfused approximately 10% of all PLT units and are the second most likely patient group to receive PLT transfusions after hematology patients 1,6,7 . Although a common intervention, there are reported variations in the rate of PLT transfusion in cardiac surgery patients between institutions 8‐10 . Being able to predict PLT transfusion in cardiac surgery would be useful both to blood services and hospitals to better anticipate demand for PLTs.…”

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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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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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“…Patient blood management (PBM), that is, defined transfusion policies, has been shown to reduce transfusion frequency without increased risk to the patients . As shown by Levy et al (2017), there is still no consensus in the literature regarding triggers for platelet transfusion. Van Hout et al reported that early platelet transfusions were associated with less postoperative blood loss but increased the risk for use of vasoactive drugs and extended mechanical ventilation, as well as prolonged stay in the intensive care unit (ICU).…”

Section: Introductionmentioning

confidence: 99%

Platelet function analysed by ROTEM platelet in cardiac surgery after cardiopulmonary bypass and platelet transfusion

Kjellberg

Holm

Lindvall

et al. 2020

Transfusion Medicine

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Objectives: The aim of this study was to investigate whether ROTEM platelet can provide additional information to the traditional ROTEM analysis to guide treatment with platelet transfusions in cardiac surgery and to identify factors triggering platelet administration. Background: Platelets play a crucial role in coagulation and haemostasis after cardiac surgery. Excessive bleeding after cardiopulmonary bypass usually requires transfusions of blood products, including platelets. The ROTEM platelet is a novel point-ofcare analysis for whole blood. Materials and methods: We included 23 patients scheduled for complex cardiac surgery. ROTEM (in-tem, ex-tem), ROTEM platelet (ARA-tem, ADP-tem and TRAP-tem) and platelet count were analysed before induction of anaesthesia (T0), after cardiopulmonary bypass and protamine reversal (T1) and after platelet transfusion (T2, n = 10). Results: ROTEM and ROTEM platelet tests were all significantly reduced between T0 and T1. ROTEM parameters improved significantly after platelet transfusion. Regarding ROTEM platelet, only TRAP-tem increased between T1 and T2 (P = .008). Factors triggering platelet transfusion were long duration of surgery and time on cardiopulmonary bypass. Conclusion: ROTEM platelet with thrombin activation, TRAP-tem, improved significantly, indicating that platelet transfusion may reverse cardiopulmonary bypassinduced platelet dysfunction. Further studies are needed to evaluate whether TRAPtem can be a valuable analysis regarding indications for transfusion of platelets after extensive cardiac surgery.

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What is the evidence for platelet transfusion in perioperative settings?

Abstract: The lack of consensus in published studies hinders our ability to draw conclusions regarding platelet transfusion and highlights the need for further studies to assess the appropriate dose and triggers for use in perioperative patients.

Cited by 21 publications

References 47 publications

Dynamics of Platelet Counts in Major Trauma: The Impact of Haemostatic Resuscitation and Effects of Platelet Transfusion—A Sub-Study of the Randomized Controlled RETIC Trial

Dynamics of Platelet Counts in Major Trauma: The Impact of Haemostatic Resuscitation and Effects of Platelet Transfusion—A Sub-Study of the Randomized Controlled RETIC Trial

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

Platelet function analysed by ROTEM platelet in cardiac surgery after cardiopulmonary bypass and platelet transfusion

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