Dose of prophylactic platelet transfusions and prevention of hemorrhage

Sherrill J. Slichter, Richard M. Kaufman, Susan F. Assmann, Jeffrey McCullough, Darrell J. Triulzi, Ronald G. Strauss, Terry B. Gernsheimer, Paul M. Ness, Mark E. Brecher, Cassandra D. Josephson, Barbara A. Konkle, Robert D. Woodson, Thomas L. Ortel, Christopher D. Hillyer, Donna L. Skerrett, Keith R. McCrae, Steven R. Sloan, Lynne Uhl, James N. George, Victor M. AquinoCatherine S. Manno, Janice G. McFarland, John R. Hess, Cindy Leissinger, Suzanne Granger

Research output: Contribution to journalArticle

337 Citations (Scopus)

Abstract

Background: We conducted a trial of prophylactic platelet transfusions to evaluate the effect of platelet dose on bleeding in patients with hypoproliferative thrombocytopenia. Methods: We randomly assigned hospitalized patients undergoing hematopoietic stem-cell transplantation or chemotherapy for hematologic cancers or solid tumors to receive prophylactic platelet transfusions at a low dose, a medium dose, or a high dose (1.1×10 11, 2.2×1011, or 4.4×1011 platelets per square meter of body-surface area, respectively), when morning platelet counts were 10,000 per cubic millimeter or lower. Clinical signs of bleeding were assessed daily. The primary end point was bleeding of grade 2 or higher (as defined on the basis of World Health Organization criteria). Results: In the 1272 patients who received at least one platelet transfusion, the primary end point was observed in 71%, 69%, and 70% of the patients in the low-dose group, the medium-dose group, and the high-dose group, respectively (differences were not significant). The incidences of higher grades of bleeding, and other adverse events, were similar among the three groups. The median number of platelets transfused was significantly lower in the low-dose group (9.25×10 11) than in the medium-dose group (11.25×1011) or the high-dose group (19.63×1011) (P = 0.002 for low vs. medium, P<0.001 for high vs. low and high vs. medium), but the median number of platelet transfusions given was significantly higher in the low-dose group (five, vs. three in the medium-dose and three in the high-dose group; P<0.001 for low vs. medium and low vs. high). Bleeding occurred on 25% of the study days on which morning platelet counts were 5000 per cubic millimeter or lower, as compared with 17% of study days on which platelet counts were 6000 to 80,000 per cubic millimeter (P<0.001). Conclusions: Low doses of platelets administered as a prophylactic transfusion led to a decreased number of platelets transfused per patient but an increased number of transfusions given. At doses between 1.1×1011 and 4.4×1011 platelets per square meter, the number of platelets in the prophylactic transfusion had no effect on the incidence of bleeding. (ClinicalTrials.gov number, NCT00128713.)

Original languageEnglish (US)
Pages (from-to)600-613
Number of pages14
JournalNew England Journal of Medicine
Volume362
Issue number7
DOIs
StatePublished - Feb 18 2010

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Platelet Transfusion
Platelet Count
Hemorrhage
Blood Platelets
Body Surface Area
Hematopoietic Stem Cell Transplantation
Incidence
Thrombocytopenia
Neoplasms
Drug Therapy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Slichter, S. J., Kaufman, R. M., Assmann, S. F., McCullough, J., Triulzi, D. J., Strauss, R. G., ... Granger, S. (2010). Dose of prophylactic platelet transfusions and prevention of hemorrhage. New England Journal of Medicine, 362(7), 600-613. https://doi.org/10.1056/NEJMoa0904084

Dose of prophylactic platelet transfusions and prevention of hemorrhage. / Slichter, Sherrill J.; Kaufman, Richard M.; Assmann, Susan F.; McCullough, Jeffrey; Triulzi, Darrell J.; Strauss, Ronald G.; Gernsheimer, Terry B.; Ness, Paul M.; Brecher, Mark E.; Josephson, Cassandra D.; Konkle, Barbara A.; Woodson, Robert D.; Ortel, Thomas L.; Hillyer, Christopher D.; Skerrett, Donna L.; McCrae, Keith R.; Sloan, Steven R.; Uhl, Lynne; George, James N.; Aquino, Victor M.; Manno, Catherine S.; McFarland, Janice G.; Hess, John R.; Leissinger, Cindy; Granger, Suzanne.

In: New England Journal of Medicine, Vol. 362, No. 7, 18.02.2010, p. 600-613.

Research output: Contribution to journalArticle

Slichter, SJ, Kaufman, RM, Assmann, SF, McCullough, J, Triulzi, DJ, Strauss, RG, Gernsheimer, TB, Ness, PM, Brecher, ME, Josephson, CD, Konkle, BA, Woodson, RD, Ortel, TL, Hillyer, CD, Skerrett, DL, McCrae, KR, Sloan, SR, Uhl, L, George, JN, Aquino, VM, Manno, CS, McFarland, JG, Hess, JR, Leissinger, C & Granger, S 2010, 'Dose of prophylactic platelet transfusions and prevention of hemorrhage', New England Journal of Medicine, vol. 362, no. 7, pp. 600-613. https://doi.org/10.1056/NEJMoa0904084
Slichter SJ, Kaufman RM, Assmann SF, McCullough J, Triulzi DJ, Strauss RG et al. Dose of prophylactic platelet transfusions and prevention of hemorrhage. New England Journal of Medicine. 2010 Feb 18;362(7):600-613. https://doi.org/10.1056/NEJMoa0904084
Slichter, Sherrill J. ; Kaufman, Richard M. ; Assmann, Susan F. ; McCullough, Jeffrey ; Triulzi, Darrell J. ; Strauss, Ronald G. ; Gernsheimer, Terry B. ; Ness, Paul M. ; Brecher, Mark E. ; Josephson, Cassandra D. ; Konkle, Barbara A. ; Woodson, Robert D. ; Ortel, Thomas L. ; Hillyer, Christopher D. ; Skerrett, Donna L. ; McCrae, Keith R. ; Sloan, Steven R. ; Uhl, Lynne ; George, James N. ; Aquino, Victor M. ; Manno, Catherine S. ; McFarland, Janice G. ; Hess, John R. ; Leissinger, Cindy ; Granger, Suzanne. / Dose of prophylactic platelet transfusions and prevention of hemorrhage. In: New England Journal of Medicine. 2010 ; Vol. 362, No. 7. pp. 600-613.
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abstract = "Background: We conducted a trial of prophylactic platelet transfusions to evaluate the effect of platelet dose on bleeding in patients with hypoproliferative thrombocytopenia. Methods: We randomly assigned hospitalized patients undergoing hematopoietic stem-cell transplantation or chemotherapy for hematologic cancers or solid tumors to receive prophylactic platelet transfusions at a low dose, a medium dose, or a high dose (1.1×10 11, 2.2×1011, or 4.4×1011 platelets per square meter of body-surface area, respectively), when morning platelet counts were 10,000 per cubic millimeter or lower. Clinical signs of bleeding were assessed daily. The primary end point was bleeding of grade 2 or higher (as defined on the basis of World Health Organization criteria). Results: In the 1272 patients who received at least one platelet transfusion, the primary end point was observed in 71{\%}, 69{\%}, and 70{\%} of the patients in the low-dose group, the medium-dose group, and the high-dose group, respectively (differences were not significant). The incidences of higher grades of bleeding, and other adverse events, were similar among the three groups. The median number of platelets transfused was significantly lower in the low-dose group (9.25×10 11) than in the medium-dose group (11.25×1011) or the high-dose group (19.63×1011) (P = 0.002 for low vs. medium, P<0.001 for high vs. low and high vs. medium), but the median number of platelet transfusions given was significantly higher in the low-dose group (five, vs. three in the medium-dose and three in the high-dose group; P<0.001 for low vs. medium and low vs. high). Bleeding occurred on 25{\%} of the study days on which morning platelet counts were 5000 per cubic millimeter or lower, as compared with 17{\%} of study days on which platelet counts were 6000 to 80,000 per cubic millimeter (P<0.001). Conclusions: Low doses of platelets administered as a prophylactic transfusion led to a decreased number of platelets transfused per patient but an increased number of transfusions given. At doses between 1.1×1011 and 4.4×1011 platelets per square meter, the number of platelets in the prophylactic transfusion had no effect on the incidence of bleeding. (ClinicalTrials.gov number, NCT00128713.)",
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T1 - Dose of prophylactic platelet transfusions and prevention of hemorrhage

AU - Slichter, Sherrill J.

AU - Kaufman, Richard M.

AU - Assmann, Susan F.

AU - McCullough, Jeffrey

AU - Triulzi, Darrell J.

AU - Strauss, Ronald G.

AU - Gernsheimer, Terry B.

AU - Ness, Paul M.

AU - Brecher, Mark E.

AU - Josephson, Cassandra D.

AU - Konkle, Barbara A.

AU - Woodson, Robert D.

AU - Ortel, Thomas L.

AU - Hillyer, Christopher D.

AU - Skerrett, Donna L.

AU - McCrae, Keith R.

AU - Sloan, Steven R.

AU - Uhl, Lynne

AU - George, James N.

AU - Aquino, Victor M.

AU - Manno, Catherine S.

AU - McFarland, Janice G.

AU - Hess, John R.

AU - Leissinger, Cindy

AU - Granger, Suzanne

PY - 2010/2/18

Y1 - 2010/2/18

N2 - Background: We conducted a trial of prophylactic platelet transfusions to evaluate the effect of platelet dose on bleeding in patients with hypoproliferative thrombocytopenia. Methods: We randomly assigned hospitalized patients undergoing hematopoietic stem-cell transplantation or chemotherapy for hematologic cancers or solid tumors to receive prophylactic platelet transfusions at a low dose, a medium dose, or a high dose (1.1×10 11, 2.2×1011, or 4.4×1011 platelets per square meter of body-surface area, respectively), when morning platelet counts were 10,000 per cubic millimeter or lower. Clinical signs of bleeding were assessed daily. The primary end point was bleeding of grade 2 or higher (as defined on the basis of World Health Organization criteria). Results: In the 1272 patients who received at least one platelet transfusion, the primary end point was observed in 71%, 69%, and 70% of the patients in the low-dose group, the medium-dose group, and the high-dose group, respectively (differences were not significant). The incidences of higher grades of bleeding, and other adverse events, were similar among the three groups. The median number of platelets transfused was significantly lower in the low-dose group (9.25×10 11) than in the medium-dose group (11.25×1011) or the high-dose group (19.63×1011) (P = 0.002 for low vs. medium, P<0.001 for high vs. low and high vs. medium), but the median number of platelet transfusions given was significantly higher in the low-dose group (five, vs. three in the medium-dose and three in the high-dose group; P<0.001 for low vs. medium and low vs. high). Bleeding occurred on 25% of the study days on which morning platelet counts were 5000 per cubic millimeter or lower, as compared with 17% of study days on which platelet counts were 6000 to 80,000 per cubic millimeter (P<0.001). Conclusions: Low doses of platelets administered as a prophylactic transfusion led to a decreased number of platelets transfused per patient but an increased number of transfusions given. At doses between 1.1×1011 and 4.4×1011 platelets per square meter, the number of platelets in the prophylactic transfusion had no effect on the incidence of bleeding. (ClinicalTrials.gov number, NCT00128713.)

AB - Background: We conducted a trial of prophylactic platelet transfusions to evaluate the effect of platelet dose on bleeding in patients with hypoproliferative thrombocytopenia. Methods: We randomly assigned hospitalized patients undergoing hematopoietic stem-cell transplantation or chemotherapy for hematologic cancers or solid tumors to receive prophylactic platelet transfusions at a low dose, a medium dose, or a high dose (1.1×10 11, 2.2×1011, or 4.4×1011 platelets per square meter of body-surface area, respectively), when morning platelet counts were 10,000 per cubic millimeter or lower. Clinical signs of bleeding were assessed daily. The primary end point was bleeding of grade 2 or higher (as defined on the basis of World Health Organization criteria). Results: In the 1272 patients who received at least one platelet transfusion, the primary end point was observed in 71%, 69%, and 70% of the patients in the low-dose group, the medium-dose group, and the high-dose group, respectively (differences were not significant). The incidences of higher grades of bleeding, and other adverse events, were similar among the three groups. The median number of platelets transfused was significantly lower in the low-dose group (9.25×10 11) than in the medium-dose group (11.25×1011) or the high-dose group (19.63×1011) (P = 0.002 for low vs. medium, P<0.001 for high vs. low and high vs. medium), but the median number of platelet transfusions given was significantly higher in the low-dose group (five, vs. three in the medium-dose and three in the high-dose group; P<0.001 for low vs. medium and low vs. high). Bleeding occurred on 25% of the study days on which morning platelet counts were 5000 per cubic millimeter or lower, as compared with 17% of study days on which platelet counts were 6000 to 80,000 per cubic millimeter (P<0.001). Conclusions: Low doses of platelets administered as a prophylactic transfusion led to a decreased number of platelets transfused per patient but an increased number of transfusions given. At doses between 1.1×1011 and 4.4×1011 platelets per square meter, the number of platelets in the prophylactic transfusion had no effect on the incidence of bleeding. (ClinicalTrials.gov number, NCT00128713.)

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