Therapeutic Platelet Transfusion for Bleeding After Traumatic Injury
Traumatic injury is associated with diffuse endothelial damage and coagulopathy, and most deaths in the first 6 h after trauma are due to bleeding. Thrombocytopenia after trauma is strongly associated with mortality, so early and aggressive platelet transfusion has been hypothesized to be beneficial. In the Pragmatic, Randomized Optimal Platelet and Plasma Ratios trial, severely injured patients who were predicted to need massive transfusion were randomized to receive initial resuscitation with plasma, platelets, and red blood cells in a 1:1:1 or 1:1:2 ratio. Blood products were delivered by cooler, and only patients in the 1:1:1 arm received platelets in the first cooler. In the subgroup of patients who received only one cooler (and were effectively randomized to get either one or zero units of apheresis platelets), those who received platelets had significantly decreased 24-h and 30-day mortality, had a greater likelihood of hemostasis, and were less likely to die by exsanguination. The American College of Surgeons (Chicago, Illinois) Trauma Quality Improvement Program now recommends transfusing red cells and platelets in a 1:1 ratio, e.g., 1 unit of apheresis platelets for every 6 units of red cells.
Anesthesiology. 2021;134(3):471-479. © 2021 American Society of Anesthesiologists | Lippincott Williams & Wilkins