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Prophylactic platelet transfusions versus no prophylaxis in hospitalized patients with thrombocytopenia: A systematic review with meta-analysis
Anthon CT, Granholm A, Sivapalan P, Zellweger N, Pène F, Puxty K, Perner A, Møller MH, Russell L
Transfusion. 2022
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Platelet to erythrocyte transfusion ratio and mortality in massively transfused trauma patients. A systematic review and meta-analysis
Rijnhout TWH, Duijst J, Noorman F, Zoodsma M, van Waes O, Verhofstad MHJ, Hoencamp R
The journal of trauma and acute care surgery. 2021
Abstract
BACKGROUND Platelet transfusion during major hemorrhage is important and often embedded in massive transfusion protocols. However, the optimal ratio of platelets to erythrocytes (platelet rich plasma (PLT) :RBC ratio) remains unclear. We hypothesized that high PLT:RBC ratios, as compared to low PLT:RBC ratios, are associated with improved survival in patients requiring massive transfusion. METHODS Four databases (Pubmed, CINAHL, EMBASE and Cochrane) were systematically screened for literature published up to January 21, 2021 to determine the effect of PLT:RBC ratio on the primary outcome measure mortality at 1-6 and 24 hours and at 28-30 days. Studies comparing various PLT:RBC ratios were included in meta-analysis. Secondary outcomes included intensive care unit length of stay and in-hospital length of stay and total blood component use. The study protocol was registered in PROSPERO under number CRD42020165648. RESULTS The search identified a total of 8903 records. After removing duplicates second screening of title, abstract and full text a total of 59 articles were included in the analysis. Of these articles 12 were included in meta-analysis. Mortality at 1-6, 24-hours and 28-30 days was significantly lower for high PLT:RBC ratios as compared to low PLT:RBC ratios. CONCLUSIONS Higher PLT:RBC ratios are associated with significantly lower 1-6 hours, 24 hours, 28-30 days mortality as compared to lower PLT:RBC ratios. The optimal PLT:RBC ratio for massive transfusion in trauma patients is approximately 1:1. LEVEL OF EVIDENCE Systematic review and meta-analysis, therapeutic level III.
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3.
The effect of platelet transfusion on functional independence and mortality after antiplatelet therapy associated spontaneous intracerebral hemorrhage: A systematic review and meta-analysis
Morris NA, Patel N, Galvagno SM Jr, Ludeman E, Schwartzbauer GT, Pourmand A, Tran QK
Journal of the neurological sciences. 2020;417:117075
Abstract
INTRODUCTION The practice of platelet transfusion to mitigate the deleterious effects of antiplatelet agents on spontaneous intracerebral hemorrhage (ICH) remains common. However, the effect of antiplatelet agents on patients with ICH is still controversial and transfusing platelets is not without risk. We performed a meta-analysis in order to determine the effect of platelet transfusion on antiplatelet agent associated ICH. METHODS We queried PubMed, Embase, and Scopus databases to identify cohort studies, case-control studies, and randomized control trials. Study quality was graded by the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool, as appropriate. Outcomes of interest included functional independence as measured by the modified Rankin Scale and mortality. We compared patients with antiplatelet agent associated ICH who received platelet transfusion to those that did not. RESULTS We identified 625 articles. After reviewing 44 full text articles, 5 were deemed appropriate for meta-analysis, including 4 cohort studies and one randomized control trial. Considerable heterogeneity was present among the studies (I(2) > 81% for all analyses). We did not find a significant effect of platelet transfusions on functional independence (Odds Ratio [OR] 1.3, 95% CI.0.45-3.9) or mortality (OR 0.58, 95% Confidence Interval [CI] 0.12-2.6). CONCLUSION We found no evidence for an effect of platelet transfusions on functional independence or mortality following antiplatelet associated ICH. More randomized trials are needed to evaluate platelet transfusion in patients with ICH and proven reduced platelet activity or those requiring neurosurgical intervention.
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4.
Effectiveness of platelet rich plasma in burn wound healing: A systematic review and meta-analysis
Zheng W, Zhao DL, Zhao YQ, Li ZY
The Journal of dermatological treatment. 2020;:1-25
Abstract
Background: To evaluate the efficacy of platelet-rich plasma (PRP) in the treatment of burn wounds.Methods: A comprehensive literature survey was conducted in electronic medical journal databases to identify studies that examined the effect of PRP treatment to burn wounds and meta-analyses of mean differences (MD) standardized MD, or odds ratios (OR) were performed.Results: The percentage of graft take was not significantly different between PRP-treated and control wound areas. Healing rate was significantly better in PRP-treated wounds. Healing time was also significantly less in PRP-treated wounds. There was no significant difference between PRP-treated and control wound areas in epithelialization, or in the incidence of adverse events. Incidence of infection was also not different between PRP-treated and control wound areas. Scar assessment score was significantly better in PRP-treated than in control wound areas.Conclusion: PRP treatment to burn wounds is found to improve healing. Variations in study design and sample size, types of wounds, PRP preparation protocols, and high risk of bias in some of the included studies may have impact on these outcomes.
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5.
The Role of Platelets in Premature Neonates with Intraventricular Hemorrhage: A Systematic Review and Meta-Analysis
Grevsen AK, Hviid CVB, Hansen AK, Hvas AM
Seminars in thrombosis and hemostasis. 2019
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Editor's Choice
Abstract
Intraventricular hemorrhage (IVH) affects up to 22% of extremely low birth weight neonates. Impaired coagulation might contribute to the pathogenesis of IVH. The aims of this study were to summarize the current knowledge on the role of platelet indices in premature neonates with IVH and to provide an overview of secondary hemostasis parameters as well as fibrinolysis in premature neonates with IVH. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases PubMed, Embase, Scopus, and Web of Science were searched on March 7, 2019, without time restrictions. In total, 30 studies were included. Most studies investigated the significance of platelet counts and/or mean platelet volume (MPV). The meta-analysis showed that at day 1 of life, neither platelet count nor MPV differed significantly between neonates with or without IVH (standardized mean difference [SMD]: -0.15 x 10(9)/L, 95% confidence interval [CI]: -0.37 to 0.07 and SMD: 0.22 fl, 95% CI: -0.07 to 0.51, respectively). However, platelet counts < 100 x 10(9)/L were associated with an increased risk of IVH. Secondary hemostasis parameters did not differ between neonates with and without IVH. Fibrinolysis was only sparsely investigated. In conclusion, platelet counts < 100 x 10(9)/L were associated with an increased risk of IVH in premature neonates. The impact of secondary hemostasis was only sparsely investigated but seemed to be minor, and the role of fibrinolysis in IVH in premature neonates needs further research. Whether reduced platelet function is associated with an increased risk of IVH in premature neonates remains to be investigated.
PICO Summary
Population
Extremely low birth weight neonates (30 studies).
Intervention
Platelet indices in neonates with IVH.
Comparison
Platelet indices in neonates without IVH.
Outcome
The meta-analysis showed that at day 1 of life, neither platelet count nor MPV differed significantly between neonates with or without IVH. However, platelet counts < 100 x 10(9)/L were associated with an increased risk of IVH. Secondary hemostasis parameters did not differ between neonates with and without IVH. Fibrinolysis was only sparsely investigated.
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Are thrombocytopenia and platelet transfusions associated with major bleeding in preterm neonates? A systematic review
Fustolo-Gunnink SF, Huijssen-Huisman EJ, van der Bom JG, van Hout FMA, Makineli S, Lopriore E, Fijnvandraat K
Blood Reviews. 2018
Abstract
Over 75% of severely thrombocytopenic preterm neonates receive platelet transfusions to prevent bleeding, but transfusion guidelines are based mainly on expert opinion. The aim of this review was to investigate whether platelet counts or transfusions are associated with major bleeding in preterm neonates. We performed a systematic search of the EMBASE and MEDLINE databases until December 2017. We included randomized trials, cohort and case control studies. (Prospero: CRD42015013399). We screened 8734 abstracts and 1225 fulltexts, identifying 36 eligible studies. In 30, timing of the platelet counts or transfusions in relation to the bleeding was unclear. Of the remaining six studies, two showed that thrombocytopenia was associated with increased risk of bleeding, two showed no such assocation, and three showed lack of an association between platelet transfusions and bleeding risk. The study results suggest that prophylactic platelet transfusions may not reduce bleeding risk in preterm neonates.
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The effect of mesenchymal stem cells combined with platelet-rich plasma on skin wound healing
Mahmoudian-Sani M R, Rafeei F, Amini R, Saidijam M
Journal of Cosmetic Dermatology. 2018;17((5):):650-659
Abstract
INTRODUCTION Mesenchymal stem cells (MSCs) are multipotent stem cells that have the potential of proliferation, high self-renewal, and the potential of multilineage differentiation. The differentiation potential of the MSCs in vivo and in vitro has caused these cells to be regarded as potentially appropriate tools for wound healing. After the burn, trauma or removal of the tumor of wide wounds is developed. Although standard treatment for skin wounds is primary healing or skin grafting, they are not always practical mainly because of limited autologous skin grafting. EVIDENCE ACQUISITIONS Directory of Open Access Journals (DOAJ), Google Scholar, PubMed (NLM), LISTA (EBSCO), and Web of Science have been searched. EVIDENCE SYNTHESIS For clinical use of the MSCs in wound healing, two key issues should be taken into account: First, engineering biocompatible scaffolds clinical use of which leads to the least amount of side effects without any immunologic response and secondly, use of stem cells secretions with the least amount of clinical complications despite their high capability of healing damage. CONCLUSION In light of the MSCs' high capability of proliferation and multilineage differentiation as well as their significant role in modulating immunity, these cells can be used in combination with tissue engineering techniques. Moreover, the MSCs' secretions can be used in cell therapy to heal many types of wounds. The combination of MSCs and PRP aids wound healing which could potentially be used to promote wound healing.
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Platelet-rich plasma for treating acute wounds: a meta-analysis . Chinese
Wang L, Gu Z, Gao C
Chung-Hua i Hsueh Tsa Chih [Chinese Medical Journal]. 2014;94((28):):2169-74.
Abstract
OBJECTIVE To evaluate the efficacy of platelet-rich plasma (PRP) in the treatment of acute wounds. METHODS Randomized controlled trials (RCT) were identified from PubMed (1950.1-2014.2), Cochrane Central Register of Controlled Trials (CENTRAL, issue 4, 2014) of Cochrane Library, China National Knowledge Infrastructure (CNKI, 1979.1-2014.2), China Biology Medicine (CBM, 1978.1-2014.2) WANFANG database (1990.1-2014.2). References of retrieved articles were also identified. The quality of each RCT was evaluated by the Cochrane collaboration's tool for assessing the risk of bias. Data analysis was performed with Review Manager 5.1 to evaluate the efficacy of PRP in the treatment of acute wounds. RESULTS A total of 13 articles involving 982 patients were included. The results of systematic review and analysis showed that wound healing time of PRP treatment group was shorter than that of control group, so did length of hospital stay (mean difference (MD): -1.45, 95%CI:-2.07 to -0.83; P < 0.01), the incidence of wound healing disturbance in PRP treatment group was less than that of control group (relative risk (RR): 0.11, 95%CI: 0.01 to 0.83; P < 0.05), so did blood product transfusion. Moreover, post-traumatic pain level of PRP treatment group was lower than that of control group (MD: -1.26, 95%CI: -1.71 to -0.82; P < 0.01). CONCLUSION Use of PRP can shorten acute wound healing time and length of hospital stay, reduce the incidence of disturbed wound healing and blood products transfusion and alleviate post-traumatic pain. Moreover, it has some effect on the control of wound infections.
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The use of higher platelet: RBC transfusion ratio in the acute phase of trauma resuscitation: a systematic review
Hallet J, Lauzier F, Mailloux O, Trottier V, Archambault P, Zarychanski R, Turgeon AF
Critical Care Medicine. 2013;41((12):):2800-11.
Abstract
OBJECTIVE With the recognition of early coagulopathy, trauma resuscitation has shifted toward liberal platelet transfusions. The overall benefit of this strategy remains controversial. Our objective was to compare the effects of a liberal use of platelet (higher platelet:RBC ratios) with a conservative approach (lower ratios) in trauma resuscitation. DATA SOURCES We systematically searched Medline, Embase, Web of Science, Biosis, Cochrane Central, and Scopus. STUDY SELECTION Two independent reviewers selected randomized controlled trials and observational studies comparing two or more platelet:RBC ratios in trauma resuscitation. We excluded studies investigating the use of whole blood or hemostatic products. DATA EXTRACTION Two independent reviewers extracted data and assessed the risk of bias. Primary outcomes were early (in ICU or within 30 d) and late (in hospital or after 30 d) mortality. Secondary outcomes were multiple organ failure, lung injury, and sepsis. DATA SYNTHESIS From 6,123 citations, no randomized controlled trials were identified. We included seven observational studies (4,230 patients) addressing confounders through multivariable regression or propensity scores. Heterogeneity of studies precluded meta-analysis. Among the five studies including exclusively patients requiring massive transfusions, four observed a lower mortality with higher ratios. Two studies considering nonmassively bleeding patients observed no benefit of using higher ratios. Two studies evaluated the implementation of a massive transfusion protocol; only one study observed a decrease in mortality with higher ratios. Of the two studies at low risk of survival bias, one study observed a survival benefit. Three studies assessed secondary outcomes. One study observed an increase in multiple organ failure with higher ratios, whereas no study demonstrated an increased risk in lung injury or sepsis. CONCLUSIONS There is insufficient evidence to strongly support the use of a precise platelet:RBC ratio for trauma resuscitation, especially in nonmassively bleeding patients. Randomized controlled trials evaluating both the safety and efficacy of liberal platelet transfusions are warranted.
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A meta-analysis to determine the effect on survival of platelet transfusions in patients with either spontaneous or traumatic antiplatelet medication-associated intracranial haemorrhage
Batchelor JS, Grayson A
BMJ Open. 2012;2((2)):e000588.
Abstract
OBJECTIVES The aim of this study was to evaluate by meta-analysis the current level of evidence in order to establish the impact of a platelet transfusion on survival in patients on pre-injury antiplatelet agents who sustain an intracranial haemorrhage (either spontaneous or traumatic). DESIGN This was a meta-analysis; the MEDLINE Database was searched using the PubMed interface and the Ovid interface. CINAHL and EMBASE Databases were also searched. The search was performed to identify randomised controlled trials (RCT)'s case-controlled studies or nested case-controlled studies. Comparing the outcome (death or survival) of patients with intracranial haemorrhage (ICH) and pre-injury antiplatelet agents who received a platelet transfusion against a similar cohort of patients who did not receive a platelet transfusion. RESULTS 499 citations were obtained from the PubMed search. 31 full articles were reviewed from 34 abstracts. 6 studies were found suitable for the meta-analysis. No randomised controlled studies were identified. 2 of the six studies were in patients with spontaneous ICH. The remaining four studies were in patients with traumatic intracranial haemorrhage. Significant heterogeneity was present between the studies, I(2)=58.276. The random effects model was therefore the preferred model, this produced a pooled OR for survival of 0.773 (95% CI 0.414 to 1.442). CONCLUSIONS The results of this meta-analysis has shown, based upon six small studies, that there was no clear benefit in terms of survival in the administration of a platelet transfusion to patients with antiplatelet-associated ICH. Further work is required in order to establish any potential benefit in the administration of a platelet transfusion in patients with spontaneous or traumatic intracranial haemorrhage who were on pre-injury antiplatelet agents.
