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The following is a summary of “Prophylactic versus restrictive platelet transfusion strategy in patients with haematological malignancies in the ICU setting, a propensity-score analysis,” published in the October 2024 issue of Critical Care by Berenger et al. 

Researchers conducted a retrospective study to evaluate whether a restrictive platelet transfusion (PT) strategy could be applied in the ICU compared to the prophylactic approach.  

They assessed patients over 18 years with hematological malignancy admitted to the ICU for thrombocytopenia (platelet count <20 G/L) between 2018 and 2021. Patients were classified into 2 groups based on the transfusion strategy used during the first 3 days: prophylactic or restrictive transfusion approach.  

The results showed that 180 patients were included, 87 were in the restrictive group and 93 in the prophylactic group. After propensity-score matching, 2 groups of 54 patients each were compared. The restrictive strategy showed a reduction in PT, with an incidence rate for 100 ICU-patient-days of 34.9 and 49.9 in the restrictive and prophylactic groups, respectively (incidence rate ratio = 0.699 [0.5–0.9], P = 0.006), a 31% reduction. This decrease in PT persisted up to day 28, with PT-free days of 21 [13–25] and 16.5 [10.2–21] in the restrictive and prophylactic groups, respectively (P = 0.04). The restrictive strategy did not lead to a higher incidence of grade ≥ 2 bleeding. The transfusion efficiency was low, with similar numbers of days with platelets <10 or <20 G/L in both strategies. The PT strategy had no effect on 28-day mortality. However, a platelet nadir <5 G/L was linked to increased day-28 mortality, with a hazard ratio of 1.882 [1.011–3.055], P = 0.046.  

Investigators concluded that a restrictive PT strategy might be a feasible approach in the ICU setting. 

Source: sciencedirect.com/science/article/abs/pii/S0883944124003046