Estcourt, L.J., Stanworth, S.J., Doree, C., Hopewell, S., Trivella, M., & Murphy, M.F. (2015). Comparison of different platelet count thresholds to guide administration of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation. Cochrane Database of Systematic Reviews, 11, CD010983.
DOI Link
Purpose
STUDY PURPOSE: To compare the efficacy and safety of different thresholds for prophylactic platelet transfusions upon the prevention of bleeding in people with hematologic disorders undergoing myelosuppressive or hematopoietic stem cell transplantation (HSCT).
TYPE OF STUDY: Systematic review
Search Strategy
DATABASES USED: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PubMed, EMBASE, CINAHL, the Transfusion Evidence Library, Web of Science, LILACS, IndMed, KoreaMed, PakMediNet, and ongoing trial databases
KEYWORDS: RCT, haematological disorders, myelosuppressive chemotherapy, HSCT, platelet transfusions, bleeding
INCLUSION CRITERIA: RCT that compared thresholds for platelet transfusions given to prevent bleeding in patients with hematologic disorders undergoing myelosuppressive chemotherapy or HSCT
EXCLUSION CRITERIA: The study included only studies comprised of patients with hematologic disorders, or, if a subpopulation was unidentified, composed of at least 80% patients with hematologic disorders. Also excluded were patients not receiving intensive chemotherapy or HCST.
Literature Evaluated
TOTAL REFERENCES RETRIEVED: 4,923 records were identified; after removal of duplicates, 3,925 records were identified for review. Twenty-nine full-text articles were reviewed after exclusion of 3,896 records.
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: This report reflects an update from reviews initially published in 2004 and updated in 2012. There were no additional trials included in this review.
Sample Characteristics
FINAL NUMBER STUDIES INCLUDED = 3
TOTAL PATIENTS INCLUDED IN REVIEW = 499 participants across three studies were included in the review.
SAMPLE RANGE ACROSS STUDIES: 78–276 patients
KEY SAMPLE CHARACTERISTICS: Patients with hematologic malignancies receiving myelosuppressive therapy or HSCT
Phase of Care and Clinical Applications
PHASE OF CARE: Active antitumor treatment
APPLICATIONS: Pediatrics, elder care
Results
There was no difference in the risk of bleeding in patients with thrombocytopenia secondary to myelosuppressive chemotherapy or HSCT when using the standard trigger of 10 x 109/L for prophylactic transfusions compared with higher thresholds (20 x 109/L or 30 x 109/L). There was evidence that using the standard trigger of 10 x 109/L for prophylactic transfusions led to a decreased number of platelet transfusions when compared with higher thresholds.
Conclusions
Based on this review, there is no evidence to recommend that the standard trigger for prophylactic platelet transfusions be increased from 10 x 109/L to either 20 x 109/L or 30 x 109/L.
Limitations
The validity of the studies were compromised as the participants and their doctors were not blinded to the study arm. In addition, the treatment effect was not precise.
Nursing Implications
There is evidence that the current standard for platelet transfusion may be safely maintained. The sequelae of decreased number of infusions may help to preserve the supply and potentially decrease the incidence of reactions.
Legacy ID
5760
