TY - JOUR
T1 - Platelet transfusions improve hemostasis and survival in a substudy of the prospective, randomized PROPPR trial
AU - PROPPR Study Group
AU - Cardenas, Jessica C.
AU - Zhang, Xu
AU - Fox, Erin E.
AU - Cotton, Bryan A.
AU - Hess, John R.
AU - Schreiber, Martin A.
AU - Wade, Charles E.
AU - Holcomb, John B.
AU - Holco, John B.
AU - Del Junco, Deborah J.
AU - Matijevic, Nena
AU - Podbielski, Jeanette
AU - Beeler, Angela M.
AU - Tilley, Barbara C.
AU - Baraniuk, Sarah
AU - Zhu, Hongjian
AU - Nixon, Joshua
AU - Seay, Roann
AU - Appana, Savitri N.
AU - Yang, Hui
AU - Gonzalez, Michael O.
AU - Baer, Lisa
AU - Wang, Yao Wei Willa
AU - Hula, Brittany S.
AU - Espino, Elena
AU - Nguyen, An
AU - Pawelczyk, Nicholas
AU - Arora-Nutall, Kisha D.
AU - Sharma, Rishika
AU - Rahbar, Elaheh
AU - Burnett, Tyrone
AU - Clark, David
AU - Van Belle, Gerald
AU - May, Susanne
AU - Leroux, Brian
AU - Hoyt, David
AU - Powell, Judy
AU - Sheehan, Kellie
AU - Hubbard, Alan
AU - Arkin, Adam P.
AU - Callum, Jeanne
AU - Vincent, Laura
AU - Welch, Timothy
AU - Poole, Tiffany
AU - Pivalizza, Evan G.
AU - Brasel, Karen J.
AU - Watters, Jennifer M.
AU - Newgard, Craig
AU - Merkel, Matthias
AU - Scanlan, Richard M.
N1 - Publisher Copyright:
© 2018 by The American Society of Hematology.
PY - 2018/7/24
Y1 - 2018/7/24
N2 - Transfusing platelets during massive hemorrhage is debated because of a lack of high-quality evidence concerning outcomes in trauma patients. The objective of this study was to examine the effect of platelet transfusions on mortality in severely injured trauma patients. This work analyzed PROPPR (Pragmatic, Randomized Optimal Platelet and Plasma Ratios) trial patients who received only the first cooler of blood products, which either did or did not contain platelets. Primary outcomes were all-cause mortality at 24 hours and 30 days and hemostasis. Secondary outcomes included cause of death, complications, and hospital-, intensive care unit (ICU)-, and ventilator-free days. Continuous variables were compared using Wilcoxon rank sum tests. Categorical variables were compared using Fisher's exact tests. There were 261 PROPPR patients who achieved hemostasis or died before receiving a second cooler of blood products (137 received platelets and 124 did not). Patients who received platelets also received more total plasma (median, 3 vs 2 U; P, .05) by PROPPR intervention design. There were no differences in total red blood cell transfusions between groups. After controlling for plasma volume, patients who received platelets had significantly decreased 24-hour (5.8% vs 16.9%; P, .05) and 30-day mortality (9.5% vs 20.2%; P, .05). More patients in the platelet group achieved hemostasis (94.9% vs 73.4%; P, .01), and fewer died as a result of exsanguination (1.5% vs 12.9%; P, .01). Patients who received platelets had a shorter time on mechanical ventilation (P, .05); however, no differences in hospital-or ICU-free days were observed. In conclusion, early platelet administration is associated with improved hemostasis and reduced mortality in severely injured, bleeding patients. This trial was registered at www.clinicaltrials.gov as # NCT01545232.
AB - Transfusing platelets during massive hemorrhage is debated because of a lack of high-quality evidence concerning outcomes in trauma patients. The objective of this study was to examine the effect of platelet transfusions on mortality in severely injured trauma patients. This work analyzed PROPPR (Pragmatic, Randomized Optimal Platelet and Plasma Ratios) trial patients who received only the first cooler of blood products, which either did or did not contain platelets. Primary outcomes were all-cause mortality at 24 hours and 30 days and hemostasis. Secondary outcomes included cause of death, complications, and hospital-, intensive care unit (ICU)-, and ventilator-free days. Continuous variables were compared using Wilcoxon rank sum tests. Categorical variables were compared using Fisher's exact tests. There were 261 PROPPR patients who achieved hemostasis or died before receiving a second cooler of blood products (137 received platelets and 124 did not). Patients who received platelets also received more total plasma (median, 3 vs 2 U; P, .05) by PROPPR intervention design. There were no differences in total red blood cell transfusions between groups. After controlling for plasma volume, patients who received platelets had significantly decreased 24-hour (5.8% vs 16.9%; P, .05) and 30-day mortality (9.5% vs 20.2%; P, .05). More patients in the platelet group achieved hemostasis (94.9% vs 73.4%; P, .01), and fewer died as a result of exsanguination (1.5% vs 12.9%; P, .01). Patients who received platelets had a shorter time on mechanical ventilation (P, .05); however, no differences in hospital-or ICU-free days were observed. In conclusion, early platelet administration is associated with improved hemostasis and reduced mortality in severely injured, bleeding patients. This trial was registered at www.clinicaltrials.gov as # NCT01545232.
UR - http://www.scopus.com/inward/record.url?scp=85060873900&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85060873900&partnerID=8YFLogxK
U2 - 10.1182/bloodadvances.2018017699
DO - 10.1182/bloodadvances.2018017699
M3 - Article
C2 - 30030268
AN - SCOPUS:85060873900
SN - 2473-9529
VL - 2
SP - 1696
EP - 1704
JO - Blood Advances
JF - Blood Advances
IS - 14
ER -