Every so often, we’re referred a patient from the hematology clinic for prophylactic platelet transfusion when their infusion center is full. As these authors state, it is common practice to routinely prophylactically transfuse platelets in the presence of severe thrombocytopenia.
And, the abstract conclusion here is: “The results of our study support the need for the continued use of prophylaxis with platelet transfusion and show the benefit of such prophylaxis for reducing bleeding, as compared with no prophylaxis.”
This conclusion is the dubious interpretation of a combined endpoint of uncertain clinical significance. Their primary endpoint was the summation of WHO 2, 3 and 4 bleeding. Nearly all their bleeding was WHO 2 – essentially, troublesome, but self-limited bleeding not requiring transfusion. With regards to major bleeding, the per-protocol rates were 5/258 in the no-prophylaxis group and 1/230 in the prophylaxis group – falling short of statistical significance, but reasonably clinically significant.
There was a 0.2 unit PRBCs per patient difference in transfusion between the prophylaxis group and the no prophylaxis group. There was, obviously, a 1.3 unit platelets per patient difference between groups. Hospitalization days were similar. No patient died from bleeding. One patient in the prophylaxis group suffered a transfusion-related anaphylactic event.
So, yes – platelet transfusions reduce bleeding. I’m just not certain these authors have demonstrated the net benefit – given 66 patients receiving prophylactic transfusions, 1 fewer non-fatal important bleeding event. Clinically insignificant net PRBC difference, significantly higher usage of platelet transfusions. I think there is plenty of room to debate cost and benefit – particularly considering interesting hypothesis-generating subgroup variation.
The authors declared multiple conflicts-of-interest, although it’s not clear to me if any of them would be relevant to the current study.
“A No-Prophylaxis Platelet-Transfusion Strategy for Hematologic Cancers”
http://www.nejm.org/doi/full/10.1056/NEJMoa1212772