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The influence of bleeding on trigger changes for platelet transfusion in patients with chemotherapy‐induced thrombocytopenia
Author(s) -
RiouxMassé Benjamin,
Laroche Vincent,
Bowman Robert J.,
Lindgren Bruce R.,
Cohn Claudia S.,
Pulkrabek Shelley M.,
McCullough Jeffrey
Publication year - 2013
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2012.03727.x
Subject(s) - medicine , major bleeding , platelet , platelet transfusion , mucocutaneous zone , population , chemotherapy , surgery , disease , myocardial infarction , environmental health
BACKGROUND: For patients with thrombocytopenia without bleeding risk factors, a platelet transfusion trigger of 10 × 10 9 /L is recommended. No studies have evaluated the clinicians' decision‐making process leading to trigger changes. STUDY DESIGN AND METHODS: We report on the evaluation of trigger changes and the relation with bleeding. Eighty patients previously enrolled in the SPRINT trial represent the patient population for the current analysis. RESULTS: Seventy‐four patients had a starting trigger of 10 × 10 9 /L. Only a minority of patients treated with chemotherapy alone (3/12, 25%) and autologous transplant (6/15, 40%) had a change in their trigger in contrast to the majority of allogeneic transplant (37/47, 79%; p = 0.001 and p = 0.009, respectively, when compared to allogeneic transplant group). Bleeding was the main reason reported by clinicians for a trigger change, but the occurrence of significant bleeding (Grade 2‐4) was similar in patients with or without a trigger change (51 and 54%, p = 1.00). Clinicians were influenced by the bleeding system: Grade 1 mucocutaneous bleeding leading to a trigger change was overrepresented (71% of cases), as was Grade 2 genitourinary bleeding not leading to a trigger change (57% of cases). CONCLUSION: A universal trigger of 10 × 10 9 /L may not be maintained in a diverse population of patients with their respective bleeding risk factors. Because the trigger is changed often, it may not be as effective as previously believed.