Platelet transfusion rates for patients in the ICU range from 5% to 15%, but guidelines are primarily based on observational studies or clinical trials in cancer patients undergoing myelosuppressive therapies. To gain a worldwide perspective of platelet transfusion practices for all ICU patients, 233 ICU centers across six continents recorded daily questionnaires related to platelet transfusions for one week and followed patients for 28 days or until discharge. Of 3,643 patients, 208 (6%) received at least one platelet transfusion in 443 transfusion events with a median of two units (IQR, 1-4 units). The percentage of patients who received platelet transfusions varied from 0% to 25% across countries. Almost all platelet transfusions occurred in high- and upper-middle income countries, while only 2% and 0% of patients in lower-middle income and low-income countries, respectively, received platelet transfusions. Platelet thresholds were listed in approximately half (224/443) of the transfusion events, and 50 X 109/L platelets was the most common threshold. The main indications for platelet transfusions were active bleeding (42%), prophylaxis (33%), and an upcoming procedure (12%). Variability in platelet transfusion practices between centers may be due to platelet availability, experience and training of physicians, and healthcare infrastructure. Future research is needed on appropriate platelet thresholds for transfusion for different subpopulations of patients.
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