TY - JOUR
T1 - The association between platelet transfusions and bleeding in critically ill patients with thrombocytopenia
AU - the PROTECT Investigators, the Canadian Critical Care Trials Group and the Australian and New Zealand Intensive Care Society Clinical Trials Group
AU - Arnold, Donald M.
AU - Lauzier, Francois
AU - Albert, Martin
AU - Williamson, David
AU - Li, Na
AU - Zarychanski, Ryan
AU - Doig, Chip
AU - McIntyre, Lauralyn
AU - Freitag, Andreas
AU - Crowther, Mark
AU - Saunders, Lois
AU - Clarke, France
AU - Bellomo, Rinaldo
AU - Qushmaq, Ismael
AU - Lopes, Renato D.
AU - Heels-Ansdell, Diane
AU - Webert, Kathryn
AU - Cook, Deborah
AU - Hall, Rick
AU - Rocker, Graeme
AU - Julien, Lisa
AU - Wright, Debbie
AU - Roy, Caroline
AU - Theriault, Judy
AU - Pleasance, Susan
AU - Meade, Maureen
AU - Hand, Lori
AU - Saunders, Lois
AU - Wynne, Christine
AU - Duffett, Mark
AU - Kho, Michelle
AU - Zytaruk, Nicole
AU - Granton, John
AU - Matte, Andrea
AU - Farias, Paulina
AU - Chu, Leslie
AU - Brockest, Nancy
AU - Go, Stephanie
AU - McGrath-Chong, Margaret
AU - Dennis, Madison
AU - Lipkus, Marc
AU - Stern, Emily
AU - Albert, Ryan
AU - Langevin, Stephan
AU - Turgeon, Alexis F.
AU - Tremblay, Marie Claude
AU - Blais, Martine
AU - Beauparlant, Maxime
AU - Nates, Joseph
AU - Haque, Sajid
N1 - Publisher Copyright:
© 2017 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals, Inc on behalf of International Society on Thrombosis and Haemostasis.
PY - 2017/7
Y1 - 2017/7
N2 - 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.
AB - 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.
KW - critical care
KW - hemorrhage
KW - mortality
KW - platelets
KW - thrombocytopenia
KW - transfusion
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U2 - 10.1002/rth2.12004
DO - 10.1002/rth2.12004
M3 - Article
C2 - 30046678
AN - SCOPUS:85063662833
SN - 2475-0379
VL - 1
SP - 103
EP - 111
JO - Research and Practice in Thrombosis and Haemostasis
JF - Research and Practice in Thrombosis and Haemostasis
IS - 1
ER -