Cid, J., & Lozano, M. (2007). Lower or higher doses for prophylactic platelet transfusions: Results of a meta-analysis of randomized controlled trials. Transfusion, 47, 464–470.
INCLUSION CRITERIA:
EXCLUSION CRITERIA: Children were excluded.
HDP groups showed a longer transfusion interval compared to the LDP group (p < 0.00001). Four studies with available data showed a significant increase in the transfusion interval when a high PLT dose was transfused. All transfused platelets were less than 24 hours old in one study and less than 72 hours old in another study. In two studies, the median number of days in which platelets were transfused was 3.71 and 2.3, respectively. In four of five trials, a significant increase in the post-transfusion PLT count increment was observed in the HDP group compared to the LDP group (p < 0.01). A significant increase in the proportion of bleeding patients was observed in the HDP group versus the LDP group. However monitoring of patients for bleeding varied, and methodologic challenges were encountered when analyzing the bleeding data. In addition, two of three trials were designed to analyze the efficacy of the transfusion of an HDP or an LDP; the presence of hemorrhage was a secondary endpoint. Only one trial was designed to look at the transfusion of lower-dose PLT in terms of safety. Outcomes only were available in three trials. No significant difference was observed in the OR of bleeding in the HDP or LDP group.
Two trials are being conducted that the authors hope will provide information to clearly define the optimal dose of PLTs to transfuse prophylactically in patients with thrombocytopenia.