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Randomized Controlled Trial
. 2015 Jun;100(6):740-7.
doi: 10.3324/haematol.2014.118075. Epub 2015 Mar 20.

Risk of bleeding and use of platelet transfusions in patients with hematologic malignancies: recurrent event analysis

Simon J Stanworth  1 , Cara L Hudson  2 , Lise J Estcourt  3 , Rachel J Johnson  2 , Erica M Wood  4 ; TOPPS study investigators
Affiliations
Randomized Controlled Trial

Risk of bleeding and use of platelet transfusions in patients with hematologic malignancies: recurrent event analysis

Simon J Stanworth et al. Haematologica. 2015 Jun.

Abstract

A recent randomized trial (TOPPS) compared prophylactic platelet transfusions (for counts <10×10(9)/L) with a strategy of no-prophylaxis in adults with hematologic malignancies. Seventy percent of enrolled patients received an autologous hematopoietic stem cell transplant. Statistical models were developed to explore which patient factors or clinical characteristics are important prognostic factors for bleeding. These models were presented for baseline characteristics and for recurrent analysis of bleeding to assess the risks of World Health Organization grade 2-4 bleeding on any given day. Additional analyses explored the importance of fever. Treatment plan (chemotherapy/allogeneic hematopoietic stem cell transplant), female sex, and treatment arm (no-prophylaxis) were significantly associated with an increased number of days of bleeding. The number of days with a platelet count <10×109/L was significantly associated with a grade 2-4 bleed (P<0.0001). Patients with a temperature of at least 38°C had the highest hazard of a grade 2-4 bleed (hazard ratio: 1.7, 95% confidence interval: 1.3 to 2.4, compared with the risk in patients with a temperature <37.5°C). There was no evidence that minor bleeding predicted a grade 2-4 bleed. The results highlighted the limited role of correction of thrombocytopenia by platelet transfusion in reducing the risk of bleeding. Clinically stable patients undergoing autologous hematopoietic stem cell transplantation had the lowest risk of bleeding and benefited least from prophylactic platelet transfusions. Prospective studies are required to address the usefulness of risk factors to support better targeted platelet transfusions. TOPPS Controlled-Trials.com number ISRCTN08758735.

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Figures

Figure 1.
Figure 1.
Shows the number of patients (Np) and number of bleeding records (Nr) included in each part of the analysis.
Figure 2.
Figure 2.
Risk-adjusted hazard ratios for grade 2–4 bleeds according to the number of days with a platelet count <10×109/L by treatment plan.
See this image and copyright information in PMC

References

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