Crighton, G.L., Estcourt, L.J., Wood, E.M., Trivella, M., Doree, C., & Stanworth, S. (2015). A therapeutic-only versus prophylactic platelet transfusion strategy for preventing bleeding in patients with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation. Cochrane Database of Systematic Reviews, 9, CD010981. 

DOI Link

Purpose

STUDY PURPOSE: To determine if prophylactic or treatment transfusion of platelets is required, and answer questions of optimal prophylactic platelet dose, platelet threshold to be used, and whether a therapeutic only strategy is as safe and effective as prophylaxis

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: CENTRAL, MEDLINE, ENBASE, CINAHL, LILACS, Web of Science, Transfusion Evidence Library, Clinicaltrials.gov, WHO International Clinical Trials Registry, ISRCTN Register, EU Clinical trials Register, Hong Kong Clinical Trials Registry, as well as handsearching and expert contacts.
 
INCLUSION CRITERIA: RCT, people with hematologic disease with myelosuppressive chemotherapy or HCT or both
 
EXCLUSION CRITERIA: Non-hematologic or HCT patients; if mixed populations, data from hematologic patients were considered separately.

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 8,408
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Method of evaluation was an assessment of bias according to the Cochrane Handbook for Systematic Reviews. GRAD 2014 was used to evaluate strength of evidence.

Sample Characteristics

FINAL NUMBER STUDIES INCLUDED = 5 studies in quantitative analysis 
 
TOTAL PATIENTS INCLUDED IN REVIEW: 1,195
 
SAMPLE RANGE ACROSS STUDIES: 12–600 patients

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results

Studies compared therapeutic only versus prophylactic platelet transfusion or placebo. The incidence of severe or life-threatening bleeding as many as 30 days from study entry was significantly different (RR = 4.91, 95% CI [0.86, 28.12]) in favor of prophylactic transfusion. Differences in other outcomes such as bleeding episodes, duration, etc., could not be estimated. There was no evidence of differences in adverse events. Patients in the therapeutic-only arm had less platelet transfusions and a shorter time to first bleeding episode. Findings regarding an appropriate platelet threshold are not provided.

Conclusions

Patients receiving therapeutic platelet transfusion may be at greater risk for bleeding than those given platelets prophylactically. There may not be an increased risk of adverse events or death if platelet transfusions are given only therapeutically.

Limitations

  • Limited number of studies included
  • Mostly low quality/high risk of bias studies
  • High heterogeneity
  • Methods for grading of bleeding and recording of bleeding varied across studies.
  • Extremely wide confidence interval

Nursing Implications

Results of this review need to be viewed with caution, as the quality of studies included was low to moderate and there was insufficient evidence to answer many questions regarding differences in outcomes. Further research would be helpful—while prophylactic platelet transfusion is the usual standard of care, and somewhat reduces risk of bleeding, there is no evidence to show any effect in terms of mortality and other disease-related outcomes. Transfusions are not risk free. Overall, there is very limited evidence for interventions to prevent bleeding.

Legacy ID

5759