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Prophylactic Platelet Transfusions for Critically Ill Patients With Thrombocytopenia

A Single-Institution Propensity-Matched Cohort Study

Warner, Matthew A., MD*; Chandran, Arun, MBBS; Frank, Ryan D., MS; Kor, Daryl J., MD, MSc*

doi: 10.1213/ANE.0000000000002794
Critical Care and Resuscitation: Original Clinical Research Report

BACKGROUND: Thrombocytopenia is frequently encountered in critically ill patients, often resulting in prophylactic transfusion of platelets for the prevention of bleeding complications. However, the efficacy of this practice remains unclear. The objective of this study was to determine the relationship between prophylactic platelet transfusion and bleeding complications in critically ill patients.

METHODS: This is a retrospective cohort study of adults admitted to surgical, medical, or combined medical-surgical intensive care units (ICUs) at a single academic institution between January 1, 2009, and December 31, 2013. Inclusion criteria included age ≥18 years and a platelet count measured during ICU admission. Propensity-matched analyses were used to evaluate associations between prophylactic platelet transfusions and the outcomes of interest with a primary outcome of red blood cell transfusion in the ensuing 24 hours and secondary outcomes of ICU and hospital-free days and changes in sequential organ failure assessment scores.

RESULTS: A total of 40,693 patients were included in the investigation with 3227 (7.9%) receiving a platelet transfusion and 1065 (33.0%) for which platelet transfusion was prophylactic in nature. In propensity-matched analyses, 994 patients with prophylactic platelet transfusion were matched to those without a transfusion. Patients receiving prophylactic platelets had significantly higher red blood cell transfusion rates (odds ratio 7.5 [5.9–9.5]; P < .001), fewer ICU-free days (mean [standard deviation] 20.8 [9.1] vs 22.7 [8.3] days; P = .004), fewer hospital-free days (13.0 [9.7] vs 15.8 [9.4] days; P < .001), and less improvement in sequential organ failure assessment scores (mean decrease of 0.2 [3.6] vs 1.8 [3.3]; P < .001) in the subsequent 24 hours. These findings appeared robust, persisting in multiple predefined sensitivity analyses.

CONCLUSIONS: Prophylactic administration of platelets in the critically ill was not associated with improved clinical outcomes, though residual confounding may exist. Further investigation of platelet transfusion strategies in this population is warranted.

From the *Department of Anesthesiology and Perioperative Medicine, Division of Critical Care Medicine, Mayo Clinic, Rochester, Minnesota

Internal Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts

Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.

Published ahead of print 28 November 2017.

Accepted for publication November 28, 2017.

Funding: The study was made possible by funding from the Mayo Clinic Department of Anesthesiology and Perioperative Medicine and the Critical Care Integrated Multidisciplinary Practice, Rochester, MN. In addition, this study was supported by an NIH R01 Grant (HL121232) to D.J.K.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Reprints will not be available from the authors.

Address correspondence to Matthew A. Warner, MD, Department of Anesthesiology and Perioperative Medicine, Division of Critical Care Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905. Address e-mail to

© 2019 International Anesthesia Research Society
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