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. 2017 May 31;1(1):103-111.
doi: 10.1002/rth2.12004. eCollection 2017 Jul.

The association between platelet transfusions and bleeding in critically ill patients with thrombocytopenia

Donald M Arnold  1   2 , Francois Lauzier  3 , Martin Albert  4 , David Williamson  5 , Na Li  6 , Ryan Zarychanski  7 , Chip Doig  8 , Lauralyn McIntyre  9 , Andreas Freitag  6 , Mark Crowther  1   10 , Lois Saunders  11 , France Clarke  11 , Rinaldo Bellomo  12 , Ismael Qushmaq  13 , Renato D Lopes  14 , Diane Heels-Ansdell  11 , Kathryn Webert  2 , Deborah Cook  1 ; PROTECT Investigators, the Canadian Critical Care Trials Group and the Australian and New Zealand Intensive Care Society Clinical Trials Group
Collaborators, Affiliations

The association between platelet transfusions and bleeding in critically ill patients with thrombocytopenia

Donald M Arnold et al. Res Pract Thromb Haemost. .

Abstract

Background: Platelet transfusions are commonly used to treat critically ill patients with thrombocytopenia. Whether platelet transfusions are associated with a reduction in the risk of major bleeding is unknown.

Patients/methods: Observational cohort study nested in a previous multicenter, randomized thromboprophylaxis trial in the intensive care unit (ICU). The objective was to evaluate the association between platelet transfusions and adjudicated major bleeding events. Platelet transfusion episodes were reviewed for timing of administration, product type, and dose. Major bleeding with and without platelet transfusions was adjusted for severity of thrombocytopenia, use of anti-platelet agents, surgery and other covariates. Secondary outcomes were thrombosis, death in ICU and platelet count increment.

Results: Among 2,256 patients, 71 (3.1%) received 190 platelet transfusions. Of those, 121 (63.7%) were administered to 54 non-bleeding, thrombocytopenic patients. Adjusted rates of major bleeding were not statistically different with or without the administration of platelet transfusions (hazard ratio for transfused patients 0.85; 95% confidence interval, 0.42-1.72). We did not find a significant association between platelet transfusion use and thrombosis or death in ICU in adjusted analyses. Thrombocytopenia, anemia, major or minor bleeding and use of anticoagulants were associated with platelet transfusion administration. The median post-transfusion platelet count increment was 20×109/L at 3.5 hours post-transfusion.

Conclusions: Rates of major bleeding were not different for patients who did and did not receive platelet transfusions. Inferences were limited by the small number of transfused patients. Clinical trials are needed to better investigate the potential hemostatic benefit and potential harms of platelet transfusions for this high-risk population.

Keywords: critical care; hemorrhage; mortality; platelets; thrombocytopenia; transfusion.

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Figures

Figure 1
Figure 1
Patients from the PROTECT trial, a randomized thromboprophylaxis trial in critically ill patients, and platelet transfusions analyzed in this study
Figure 2
Figure 2
Average platelet count increment and 95% confidence interval at specified times after the transfusion
See this image and copyright information in PMC

References

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