Crighton, G.L., Estcourt, L.J., Wood, E.M., Trivella, M., Doree, C., & Stanworth, S. (2015). A therapeutic-only versus prophylactic platelet transfusion strategy for preventing bleeding in patients with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation. Cochrane Database of Systematic Reviews, 9, CD010981.
STUDY PURPOSE: To determine if prophylactic or treatment transfusion of platelets is required, and answer questions of optimal prophylactic platelet dose, platelet threshold to be used, and whether a therapeutic only strategy is as safe and effective as prophylaxis
TYPE OF STUDY: Meta-analysis and systematic review
PHASE OF CARE: Active antitumor treatment
Studies compared therapeutic only versus prophylactic platelet transfusion or placebo. The incidence of severe or life-threatening bleeding as many as 30 days from study entry was significantly different (RR = 4.91, 95% CI [0.86, 28.12]) in favor of prophylactic transfusion. Differences in other outcomes such as bleeding episodes, duration, etc., could not be estimated. There was no evidence of differences in adverse events. Patients in the therapeutic-only arm had less platelet transfusions and a shorter time to first bleeding episode. Findings regarding an appropriate platelet threshold are not provided.
Patients receiving therapeutic platelet transfusion may be at greater risk for bleeding than those given platelets prophylactically. There may not be an increased risk of adverse events or death if platelet transfusions are given only therapeutically.
Results of this review need to be viewed with caution, as the quality of studies included was low to moderate and there was insufficient evidence to answer many questions regarding differences in outcomes. Further research would be helpful—while prophylactic platelet transfusion is the usual standard of care, and somewhat reduces risk of bleeding, there is no evidence to show any effect in terms of mortality and other disease-related outcomes. Transfusions are not risk free. Overall, there is very limited evidence for interventions to prevent bleeding.