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Platelet transfusion: a systematic review of the clinical evidence
Author(s) -
Kumar Ambuj,
Mhaskar Rahul,
Grossman Brenda J.,
Kaufman Richard M.,
Tobian Aaron A.R.,
Kleinman Steven,
Gernsheimer Terry,
Tinmouth Alan T.,
Djulbegovic Benjamin
Publication year - 2015
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.12943
Subject(s) - observational study , medicine , platelet transfusion , randomized controlled trial , transfusion medicine , systematic review , intensive care medicine , blood transfusion , medline , surgery , platelet , political science , law
Background Platelet ( PLT ) transfusion is indicated either prophylactically or therapeutically to reduce the risk of bleeding or to control active bleeding. Significant uncertainty exists regarding the appropriate use of PLT transfusion and the optimal threshold for transfusion in various settings. We formulated 12 key questions to assess the role of PLT transfusion. Study Design and Methods We performed a systematic review ( SR ) of randomized controlled trials ( RCT s) and observational studies. A comprehensive search of P ub M ed, W eb of S cience, and C ochrane registry of controlled trials was performed. Methodologic quality of included studies was assessed and a meta‐analysis was performed if more than two studies with similar designs were identified for a specific question. Results Seventeen RCT s and 55 observational studies were included in the final SR . Results from RCT s showed a beneficial effect of prophylactic compared with therapeutic transfusion for the prevention of significant bleeding in patients with hematologic disorders undergoing chemotherapy or stem cell transplantation. We found no difference in significant bleeding events related to the PLT count threshold for transfusion or the dose of PLT s transfused. Overall methodologic quality of RCT s was moderate. Results from observational studies showed no evidence that PLT transfusion prevented significant bleeding in patients undergoing central venous catheter insertions, lumbar puncture, or other surgical procedures. The methodologic quality of observational studies was very low. Conclusion We provide a comprehensive assessment of evidence on the use of PLT transfusions in a variety of clinical settings. Our report summarizes current knowledge and identifies gaps to be addressed in future research.