VIDEO: Randomized Trial of Prophylactic Platelet Transfusions

A trial which randomized 600 haematological cancer patients to receive or not to receive prophylactic platelet transfusions showed that prophylactic transfusion was associated with reduced risk of bleeding.

Previous research had demonstrated that the thresholds for prophylactic platelet transfusion could be safely reduced to 10,000 in patients with hypoproliferative thrombocytopenia.

Here is Dr. Michael Murphy, who led the study with his colleague Simon Stanworth: “The goal of platelet transfusions is to prevent severe bleeding in patients with thrombocytopenia. This aim needs to be balanced against the risks associated with platelet transfusions as well as the costs and the challenge of maintaining an adequate supply.”

Dr. Murphy’s study found that while bleeding of WHO grade 2 or higher was common across both trial arms, the rate of bleeding was 8.4 percentage points greater among patients not receiving prophylactic transfusions.

Again, here is Dr. Murphy: “Patients in the no-prophylaxis group had more days of bleeding – 1.7 as against 1.2 days – and a shorter time to the first bleeding episode – 17 against 20 days – than patients receiving prophylactic platelet transfusions. More patients in the no-prophylaxis group had WHO grade 3 or 4 bleeding (2% against less than 1%) but this difference was not significant.”

The trial included a pre-specified subgroup analysis of patients undergoing autologous hematopoietic stem cell transplantation. This analysis found that among these patients, there was no significant difference in the incidence of substantial bleeding between trial arms. Another recent trial from Germany, however, found conflicting results. Dr. Murphy explains: “The results differ from the recent German trial which found higher rates of grade 2 or greater bleeding in this subgroup of patients with a no prophylaxis strategy. Our trial was not sufficiently powered to specifically address the question of the effectiveness of no-prophylaxis in autologous stem cell transplant patients, and this issue requires further research.”

Dr. Sherrill Slichter who wrote an accompanying editorial noted: “In my opinion, the reduction in the use of platelet transfusions with the therapeutic only versus prophylactic platelet transfusion strategy does not justify subjecting patients to the increased bleeding risks associated with a therapeutic-only platelet-transfusion strategy.”

Further research is needed to develop additional measures to reduce bleeding.

We’ll be back with another edition of Transfusion News on June 30th.  Thanks for joining us.

References

1.    Stanworth SJ, Estcourt LJ, Powter G, Kahan BC, Dyer C, Choo L, Bakrania L, Llewelyn C, Littlewood T, Soutar R, Norfolk D, Copplestone A, Smith N, Kerr P, Jones G, Raj K, Westerman DA, Szer J, Jackson N, Bardy PG, Plews D, Lyons S, Bielby L, Wood EM, Murphy MF. A no-prophylaxis platelet-transfusion strategy for hematologic cancers. N Engl J Med 2013;368: 1771-80.

2.    Slichter SJ. Eliminate prophylactic platelet transfusions? N Engl J Med 2013;368: 1837-8.

3.    Wandt H, Schaefer-Eckart K, Wendelin K, Pilz B, Wilhelm M, Thalheimer M, Mahlknecht U, Ho A, Schaich M, Kramer M, Kaufmann M, Leimer L, Schwerdtfeger R, Conradi R, Dolken G, Klenner A, Hanel M, Herbst R, Junghanss C, Ehninger G. Therapeutic platelet transfusion versus routine prophylactic transfusion in patients with haematological malignancies: an open-label, multicentre, randomised study. Lancet 2012;380: 1309-16.