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Meta-Analysis
. 2019 Nov;59(11):3337-3349.
doi: 10.1111/trf.15540. Epub 2019 Oct 15.

Does the evidence support the importance of high transfusion ratios of plasma and platelets to red blood cells in improving outcomes in severely injured patients: a systematic review and meta-analyses

Luis Teodoro da Luz  1 , Prakesh S Shah  2 , Rachel Strauss  1 , Ayman Abdelhady Mohammed  1 , Pablo Perez D'Empaire  3 , Homer Tien  1 , Avery B Nathens  1 , Barto Nascimento  1
Affiliations
Meta-Analysis

Does the evidence support the importance of high transfusion ratios of plasma and platelets to red blood cells in improving outcomes in severely injured patients: a systematic review and meta-analyses

Luis Teodoro da Luz et al. Transfusion. 2019 Nov.

Abstract

Background: Deaths by exsanguination in trauma are preventable with hemorrhage control and resuscitation with allogeneic blood products (ABPs). The ideal transfusion ratio is unknown. We compared efficacy and safety of high transfusion ratios of FFP:RBC and PLT:RBC with low ratios in trauma.

Study design and methods: Medline, Embase, Cochrane, and Controlled Clinical Trials Register were searched. Observational and randomized data were included. Risk of bias was assessed using validated tools. Primary outcome was 24-h and 30-day mortality. Secondary outcomes were exposure to ABPs and improvement of coagulopathy. Meta-analysis was conducted using a random-effects model. Strength and evidence quality were graded using GRADE profile RESULTS: 55 studies were included (2 randomized and 53 observational), with low and moderate risk of bias, respectively, and overall low evidence quality. The two RCTs showed no mortality difference (odds ratio [OR], 1.35; 95% confidence interval [CI], 0.40-4.59). Observational studies reported lower mortality in high FFP:RBCs ratio (OR, 0.38 [95% CI, 0.22-0.68] for 1:1 vs. <1:1; OR, 0.42 [95% CI, 0.22-0.81] for 1:1.5 vs. <1:1.5; and OR, 0.47 [95% CI, 0.31-0.71] for 1:2 vs. <1:2, respectively). Meta-analyses in observational studies showed no difference in exposure to ABPs. No data on coagulopathy for meta-analysis was identified.

Conclusions: Meta-analyses in observational studies suggest survival benefit and no difference in exposure to ABPs. No survival benefit in RCTs was identified. These conflicting results should be interpreted with caution. Studies are mostly observational, with relatively small sample sizes, nonrandom treatment allocation, and high potential for confounding. Further research is warranted.

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Conflict of interest statement

The authors have disclosed no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow chart of study selection. [Color figure can be viewed at http://wileyonlinelibrary.com]
Figure 2
Figure 2
Thirty‐day mortality in RCTs. High ratios in both studies were 1:1:1 (FFP:PLTs:RBCs in Holcomb's and RBCs:FFP:PLTs in Nascimento's trial). Low ratio in Holcomb's trial was 1:1:2 (FFP:PLTs:RBCs) and in Nascimento's trial it was 1.8:1:0.7 (RBCs:FFP:PLTs). [Color figure can be viewed at http://wileyonlinelibrary.com]
Figure 3
Figure 3
Twenty‐four‐hour mortality in non‐RCTs according to the FFP:RBC ratio assessed. [Color figure can be viewed at http://wileyonlinelibrary.com]
Figure 4
Figure 4
Thirty‐day mortality in non‐RCTs according to the FFP:RBC ratio assessed. [Color figure can be viewed at http://wileyonlinelibrary.com]
See this image and copyright information in PMC

References

    1. US Centers for Disease Control and Prevention. Injury prevention and control: data and statistics (WISQARS), 2014. Accessed September 2019.
    1. Gruen RL, Jurkovich GJ, McIntyre LK, et al. Patterns of errors contributing to trauma mortality: lessons learned from 2,594 deaths. Ann Surg 2006;244:371‐80. - PMC - PubMed
    1. Hess JR, Brohi K, Dutton RP, et al. The coagulopathy of trauma: a review of mechanisms. J Trauma 2008;65:748‐54. - PubMed
    1. Tisherman SA, Schmicker RH, Brasel KJ, et al. Detailed description of all deaths in both the Shock and Traumatic Brain Injury Hypertonic Saline Trials of the Resuscitation Outcomes Consortium. Ann Surg 2014;252:149‐57. 10.1097/SLA.0b013e3181df0401. - DOI - PMC - PubMed
    1. Stahel P, Moore E, Schreier L, et al. Transfusion strategies in postinjury coagulopathy. Curr Opin Anaesthesiol 2009;22:289‐98. - PubMed

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