Platelet Transfusion Threshold in Patients With Upper Gastrointestinal Bleeding: A Systematic Review
Journal of Clinical Gastroenterology, 06/26/2012
Razzaghi A et al. – There exist a paucity of data to recommend optimal therapeutic platelet count targets in patients with active GI bleeding. Based principally on expert opinion recommendations, the authors propose a count of 50×109/L. Some professional associations have suggested in very specific clinical settings (postcardiopulmonary bypass surgery or central nervous system trauma) a higher value of up to 100×109/L. Properly designed randomized trials are required to more precisely address this important clinical question.Methods
- A systematic review was carried out to determine the optimal approach when managing patients with thrombocytopenia in the setting of nonvariceal upper GI bleeding.
- Eighteen of 803 potential articles were selected and reviewed, including 4 randomized controlled trials and 6 cohort studies.
- The only empirical clinical data available pertained to the management of hematology or oncology patients.
- There was no high-level evidence that determined the proper threshold of platelet transfusion specifically in GI bleeding.
- The authors were, therefore, limited to include principally consensus opinions, recommendations, and guidelines for platelet transfusion trigger as they apply to the treatment (including prophylaxis) of bleeding in general, with a paucity of data addressing major bleeding, let alone bleeding from a gastroenterologic origin.
- Randomized clinical trials were individually underpowered in allowing definitive conclusions, even though resulting recommendations were supported by similarly underpowered retrospective and prospective observational studies.