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Impact of prophylactic platelet transfusions on bleeding events in patients with hematologic malignancies: a subgroup analysis of a randomized trial (CME)
Author(s) -
Stanworth Simon J.,
Estcourt Lise J.,
Llewelyn Charlotte A.,
Murphy Michael F.,
Wood Erica M.
Publication year - 2014
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/trf.12646
Subject(s) - medicine , hazard ratio , subgroup analysis , randomized controlled trial , platelet transfusion , confidence interval , hematopoietic stem cell transplantation , chemotherapy , surgery , transplantation , platelet
Background A recent randomized trial compared a policy of no prophylaxis with a policy of prophylactic platelet ( PLT ) transfusions at counts of fewer than 10 × 10 9 / L in patients with hematologic malignancies. The results suggested the effectiveness of prophylactic PLT transfusions may vary according to patient diagnosis and treatment plan. Study Design and Methods This article presents full subgroup analyses and compares treatment effects between autologous hematopoietic stem cell transplantation (auto HSCT ; n = 421) and chemotherapy/allogeneic HSCT (chemo/allo HSCT ; n = 179) patients. Results Prespecified subgroup analysis found that the reduction in proportion of patients experiencing WHO G rade 2 to 4 bleeds (main trial outcome) seen in the prophylaxis arm was of greater magnitude in chemo/allo HSCT than auto HSCT patients (interaction p = 0.04). Analysis of secondary outcomes showed a shorter time to first bleeding episode with no prophylaxis in the chemo/allo HSCT group (hazard ratio, 1.84; 95% confidence interval CI , 1.21‐2.79; p = 0.004) compared to the auto HSCT group (hazard ratio, 1.12; 95% CI , 0.85‐1.48; p = 0.4; interaction p = 0.08). The increased number of days with G rade 2 to 4 bleeds with a no‐prophylaxis policy was similar in chemo/allo HSCT (rate ratio, 1.89; 95% CI , 1.10‐3.26) and in auto HSCT patients (rate ratio, 1.43; 95% CI , 1.04‐1.97). Both subgroups showed significant reductions in PLT transfusions with a no‐prophylaxis strategy. Conclusion There is evidence that the effectiveness of prophylactic PLT transfusions may differ between subgroups, with chemo/allo HSCT patients receiving prophylactic PLT transfusions appearing to show a greater reduction in bleeding outcomes compared to patients following a no‐prophylaxis policy.