Platelet transfusions improve hemostasis and survival in a substudy of the prospective, randomized PROPPR trial

PROPPR Study Group

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Transfusing platelets during massive hemorrhage is debated because of a lack of high-quality evidence concerning outcomes in trauma patients. The objective of this study was to examine the effect of platelet transfusions on mortality in severely injured trauma patients. This work analyzed PROPPR (Pragmatic, Randomized Optimal Platelet and Plasma Ratios) trial patients who received only the first cooler of blood products, which either did or did not contain platelets. Primary outcomes were all-cause mortality at 24 hours and 30 days and hemostasis. Secondary outcomes included cause of death, complications, and hospital-, intensive care unit (ICU)-, and ventilator-free days. Continuous variables were compared using Wilcoxon rank sum tests. Categorical variables were compared using Fisher's exact tests. There were 261 PROPPR patients who achieved hemostasis or died before receiving a second cooler of blood products (137 received platelets and 124 did not). Patients who received platelets also received more total plasma (median, 3 vs 2 U; P, .05) by PROPPR intervention design. There were no differences in total red blood cell transfusions between groups. After controlling for plasma volume, patients who received platelets had significantly decreased 24-hour (5.8% vs 16.9%; P, .05) and 30-day mortality (9.5% vs 20.2%; P, .05). More patients in the platelet group achieved hemostasis (94.9% vs 73.4%; P, .01), and fewer died as a result of exsanguination (1.5% vs 12.9%; P, .01). Patients who received platelets had a shorter time on mechanical ventilation (P, .05); however, no differences in hospital-or ICU-free days were observed. In conclusion, early platelet administration is associated with improved hemostasis and reduced mortality in severely injured, bleeding patients. This trial was registered at www.clinicaltrials.gov as # NCT01545232.

Original languageEnglish (US)
Pages (from-to)1696-1704
Number of pages9
JournalBlood Advances
Volume2
Issue number14
DOIs
StatePublished - Jul 24 2018

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Platelet Transfusion
Hemostasis
Blood Platelets
Survival
Mortality
Nonparametric Statistics
Intensive Care Units
Hemorrhage
Exsanguination
Erythrocyte Transfusion
Plasma Volume
Wounds and Injuries
Mechanical Ventilators
Artificial Respiration
Cause of Death

ASJC Scopus subject areas

  • Hematology

Cite this

Platelet transfusions improve hemostasis and survival in a substudy of the prospective, randomized PROPPR trial. / PROPPR Study Group.

In: Blood Advances, Vol. 2, No. 14, 24.07.2018, p. 1696-1704.

Research output: Contribution to journalArticle

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abstract = "Transfusing platelets during massive hemorrhage is debated because of a lack of high-quality evidence concerning outcomes in trauma patients. The objective of this study was to examine the effect of platelet transfusions on mortality in severely injured trauma patients. This work analyzed PROPPR (Pragmatic, Randomized Optimal Platelet and Plasma Ratios) trial patients who received only the first cooler of blood products, which either did or did not contain platelets. Primary outcomes were all-cause mortality at 24 hours and 30 days and hemostasis. Secondary outcomes included cause of death, complications, and hospital-, intensive care unit (ICU)-, and ventilator-free days. Continuous variables were compared using Wilcoxon rank sum tests. Categorical variables were compared using Fisher's exact tests. There were 261 PROPPR patients who achieved hemostasis or died before receiving a second cooler of blood products (137 received platelets and 124 did not). Patients who received platelets also received more total plasma (median, 3 vs 2 U; P, .05) by PROPPR intervention design. There were no differences in total red blood cell transfusions between groups. After controlling for plasma volume, patients who received platelets had significantly decreased 24-hour (5.8{\%} vs 16.9{\%}; P, .05) and 30-day mortality (9.5{\%} vs 20.2{\%}; P, .05). More patients in the platelet group achieved hemostasis (94.9{\%} vs 73.4{\%}; P, .01), and fewer died as a result of exsanguination (1.5{\%} vs 12.9{\%}; P, .01). Patients who received platelets had a shorter time on mechanical ventilation (P, .05); however, no differences in hospital-or ICU-free days were observed. In conclusion, early platelet administration is associated with improved hemostasis and reduced mortality in severely injured, bleeding patients. This trial was registered at www.clinicaltrials.gov as # NCT01545232.",
author = "{PROPPR Study Group} and Cardenas, {Jessica C.} and Xu Zhang and Fox, {Erin E.} and Cotton, {Bryan A.} and Hess, {John R.} and Schreiber, {Martin A.} and Wade, {Charles E.} and Holcomb, {John B.} and Holco, {John B.} and {Del Junco}, {Deborah J.} and Nena Matijevic and Jeanette Podbielski and Beeler, {Angela M.} and Tilley, {Barbara C.} and Sarah Baraniuk and Hongjian Zhu and Joshua Nixon and Roann Seay and Appana, {Savitri N.} and Hui Yang and Gonzalez, {Michael O.} and Lisa Baer and Wang, {Yao Wei Willa} and Hula, {Brittany S.} and Elena Espino and An Nguyen and Nicholas Pawelczyk and Arora-Nutall, {Kisha D.} and Rishika Sharma and Elaheh Rahbar and Tyrone Burnett and David Clark and {Van Belle}, Gerald and Susanne May and Brian Leroux and David Hoyt and Judy Powell and Kellie Sheehan and Alan Hubbard and Arkin, {Adam P.} and Jeanne Callum and Laura Vincent and Timothy Welch and Tiffany Poole and Pivalizza, {Evan G.} and Gumbert, {Sam D.} and Yu Bai and McCarthy, {James J.} and Amy Noland and Rhonda Hobbs",
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AU - PROPPR Study Group

AU - Cardenas, Jessica C.

AU - Zhang, Xu

AU - Fox, Erin E.

AU - Cotton, Bryan A.

AU - Hess, John R.

AU - Schreiber, Martin A.

AU - Wade, Charles E.

AU - Holcomb, John B.

AU - Holco, John B.

AU - Del Junco, Deborah J.

AU - Matijevic, Nena

AU - Podbielski, Jeanette

AU - Beeler, Angela M.

AU - Tilley, Barbara C.

AU - Baraniuk, Sarah

AU - Zhu, Hongjian

AU - Nixon, Joshua

AU - Seay, Roann

AU - Appana, Savitri N.

AU - Yang, Hui

AU - Gonzalez, Michael O.

AU - Baer, Lisa

AU - Wang, Yao Wei Willa

AU - Hula, Brittany S.

AU - Espino, Elena

AU - Nguyen, An

AU - Pawelczyk, Nicholas

AU - Arora-Nutall, Kisha D.

AU - Sharma, Rishika

AU - Rahbar, Elaheh

AU - Burnett, Tyrone

AU - Clark, David

AU - Van Belle, Gerald

AU - May, Susanne

AU - Leroux, Brian

AU - Hoyt, David

AU - Powell, Judy

AU - Sheehan, Kellie

AU - Hubbard, Alan

AU - Arkin, Adam P.

AU - Callum, Jeanne

AU - Vincent, Laura

AU - Welch, Timothy

AU - Poole, Tiffany

AU - Pivalizza, Evan G.

AU - Gumbert, Sam D.

AU - Bai, Yu

AU - McCarthy, James J.

AU - Noland, Amy

AU - Hobbs, Rhonda

PY - 2018/7/24

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