title: Platelet transfusions in platelet consumptive disorders are associated with arterial thrombosis and in-hospital mortality.
abstract: While platelets are primary mediators of hemostasis, there is emerging evidence to show that they may also mediate pathologic thrombogenesis. Little data are available on risks and benefits associated with platelet transfusions in thrombotic thrombocytopenic purpura (TTP), heparin-induced thrombocytopenia (HIT) and immune thrombocytopenic purpura (ITP). This study utilized the Nationwide Inpatient Sample to evaluate the current in-hospital platelet transfusion practices and their association with arterial/venous thrombosis, acute myocardial infarction (AMI), stroke, and in-hospital mortality over 5 years (2007-2011). Age and gender-adjusted odds ratios (adjOR) associated with platelet transfusions were calculated. There were 10 624 hospitalizations with TTP; 6332 with HIT and 79 980 with ITP. Platelet transfusions were reported in 10.1% TTP, 7.1% HIT, and 25.8% ITP admissions. Platelet transfusions in TTP were associated with higher odds of arterial thrombosis (adjOR = 5.8, 95%CI = 1.3-26.6), AMI (adjOR = 2.0, 95%CI = 1.2-3.3) and mortality (adjOR = 2.0,95%CI = 1.3-3.0), but not venous thrombosis. Platelet transfusions in HIT were associated with higher odds of arterial thrombosis (adjOR = 3.4, 95%CI = 1.2-9.5) and mortality (adjOR = 5.2, 95%CI = 2.6-10.5) but not venous thrombosis. Except for AMI, all relationships remained significant after adjusting for clinical severity and acuity. No associations were significant for ITP. Platelet transfusions are associated with higher odds of arterial thrombosis and mortality among TTP and HIT patients.
authors.affiliation: Division of Transfusion Medicine, Department of Pathology, and Division of Pediatric Hematology, Johns Hopkins University, Baltimore, MD; and.
authors.forename: Ruchika
authors.initials: R
authors.lastname: Goel
authors.affiliation: Division of Transfusion Medicine, Department of Pathology, and.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Ness
authors.affiliation: Division of Pediatric Hematology, Johns Hopkins University, Baltimore, MD; and.
authors.forename: Clifford M
authors.initials: CM
authors.lastname: Takemoto
authors.affiliation: Division of Pediatric Blood and Bone Marrow Transplantation, Emory University School of Medicine, Atlanta, GA.
authors.forename: Lakshmanan
authors.initials: L
authors.lastname: Krishnamurti
authors.affiliation: Division of Transfusion Medicine, Department of Pathology, and.
authors.forename: Karen E
authors.initials: KE
authors.lastname: King
authors.affiliation: Division of Transfusion Medicine, Department of Pathology, and.
authors.forename: Aaron A R
authors.initials: AA
authors.lastname: Tobian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001791:Blood Platelet Disorders / Q000209:etiology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000628:therapy; D017713:Platelet Transfusion / Q000009:adverse effects*; D011379:Prognosis; D011696:Purpura, Thrombocytopenic / Q000209:etiology* / Q000401:mortality; D020521:Stroke / Q000150:complications* / Q000628:therapy; D015996:Survival Rate; D013927:Thrombosis / Q000209:etiology* / Q000401:mortality; D055815:Young Adult