Stanworth, S.J., Hyde, C., Heddle, N., Rebulla, P., Brunskill, S., & Murphy, M.F. (2004). Prophylactic platelet transfusion for haemorrhage after chemotherapy and stem cell transplantation. Cochrane Database of Systemic Reviews, CD004269.

DOI Link

Purpose

To determine the optimal use of prophylactic platelet transfusion for the prevention of hemorrhage after chemotherapy and stem cell transplantation

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 8  
  • TOTAL PATIENTS INCLUDED IN REVIEW = 390 in the intervention group and 362 in the control group  
  • KEY SAMPLE CHARACTERISTICS: Three trials compared prophylactic platelet transfusions to therapeutic platelet transfusions. Three trials compared prophylactic platelet transfusions with different transfusion trigger levels. Two trials compared prophylactic platelet transfusion with varying dose schedules.

 

Conclusions

Prophylactic versus therapeutic transfusions: Policies on red-cell transfusion varied; not all patients randomized in the trials were included in the final analysis; none of the trials clearly defined the aims of the study; studies should be considered hypothesis rather than definitive equivalence testing.
 
Prophylactic platelet transfusion with various trigger levels: All parallel RCTs; one study reported power calculation; all three trials compared platelet triggers of 10 x 109/liter and 20 x 109/liter, but there were some differences between studies in what was being compared.
 
Prophylactic platelet transfusion with varying dose schedules: Difficult to compare doses of platelets in both trials because different transfusion units were reported; difference in design and other factors limited a meaningful combined analysis.

Limitations

  • Studies included few patients, and it was not clear whether a lack of difference in studies was a reflection of the lack of power.
  • Even with combined studies, analysis is underpowered.
  • Literature is dated, with the majority of studies undertaken more than 25 years ago.
     

Nursing Implications

The studies provide no indication to change the current practice guidelines recommending prophylactic platelet thresholds of 10 x 109/liter, but uncertainty with this body of literature should be recognized. There is a need for trials with adequate power that compare prophylactic to therapeutic platelet transfusion.
 

Legacy ID

2864