Transfusion Evidence Alert and Round-Up

On this page you can view articles from previous editions of the Transfusion Evidence Alert and Round-Up. You can also use the button on the left to sign up to receive future editions direct to your inbox.

The Transfusion Evidence Alert is a monthly overview of the top ten evidence-based publications in the field of transfusion medicine. The articles are selected for quality and relevance by clinical experts, supported by members of the Systematic Review Initiative.

The Transfusion Evidence Round-Up is a quarterly overview of the top 10 high quality studies about an internationally relevant subject in the field of transfusion medicine. The articles are selected by members from the International Society of Blood Transfusion and drawn from the Transfusion Evidence Library and, where relevant, Stem Cell Evidence.

Register here to receive the free monthly Transfusion Evidence Alert and the quarterly Round-Up direct to your email account each month.
Editor's Choice

Pre-procedural use of thrombopoietin-receptor agonists in cirrhosis and severe thrombocytopenia: A systematic review and meta-analysis

Dig Liver Dis. 2021 Nov;53(11):1396-1403 doi: 10.1016/j.dld.2021.07.015.
PICO Summary
POPULATION:

Adults with cirrhosis and severe thrombocytopenia undergoing elective invasive procedures (6 randomised controlled trials, n= 1,229).

INTERVENTION:

Thrombopoietin-receptor (TPO) agonists pre-procedure.

COMPARISON:

Placebo.

OUTCOME:

All the included studies had low risk of bias. Compared with placebo, those treated with TPO-agonists had a pooled odds ratio (OR) of 0.12 (0.08-0.17) for platelet transfusion avoidance, and weighted mean difference in platelet count (x10 3 /µL) of 35.6 (28.6-42.7). Major adverse events did not differ between groups (Pooled OR: 0.87 (0.47-1.62)).

Abstract
BACKGROUND:

Severe thrombocytopenia in cirrhosis can preclude invasive procedures. Platelet transfusion is recommended if platelet count pre-procedure is potential alternative to platelet transfusion is thrombopoietin-receptor (TPO) agonists.

AIM:

Evaluate TPO-agonist efficacy and safety in cirrhotic patients with severe thrombocytopenia undergoing invasive procedures.

METHODS:

Randomized control trials (RCT) from electronic reference databases were searched from inception till December 2019. PRISMA guidelines were followed. Primary outcome was platelet transfusion avoidance. Secondary outcomes were weighted mean difference (WMD) in platelet count from baseline to pre-procedure and rates of major adverse events (AE). Pooled Odds Ratio (OR) were estimated using a random-effects model.

RESULTS:

Six RCTs with 1,229 patients were included. All studies had low risk of bias. Compared with placebo, those treated with TPO-agonists had a pooled OR of 0.12(0.08-0.17), P<0.01 for platelet transfusion avoidance, and WMD in platelet count (x10 3 /µL) of 35.6(28.6-42.7), P<0.01. Major AE did not differ between groups [Pooled OR: 0.87(0.47-1.62), P=0.66].

CONCLUSION:

Compared to placebo, TPO-agonists used in cirrhotic patients with severe thrombocytopenia prior to elective invasive procedures had 88% reduced odds of requiring peri-procedural platelet transfusion and increased platelet count pre-procedure, with no difference in AE rates.

Metadata
KEYWORDS: Liver cirrhosis; Portal hypertension; thrombocytopenia
MESH HEADINGS: Elective Surgical Procedures; Humans; Liver Cirrhosis; Platelet Count; Preoperative Care; Randomized Controlled Trials as Topic; Receptors, Thrombopoietin; Thrombocytopenia
Study Details
Study Design: Systematic Review
Language: eng
Additional Material: Correction in: ‘Digestive and Liver Disease: official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver’ (2021), PMID: 34815193, DOI: http://dx.doi.org/10.1016/j.dld.2021.11.001
Credits: Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine