Platelet to erythrocyte transfusion ratio and mortality in massively transfused trauma patients. A systematic review and meta-analysis

T.W.H. Rijnhout*, J. Duijst, F. Noorman, M. Zoodsma, O.J.F. van Waes, M.H.J. Verhofstad, R. Hoencamp

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

1 Citation (Web of Science)

Abstract

BACKGROUND Platelet transfusion during major hemorrhage is important and often embedded in massive transfusion protocols. However, the optimal ratio of platelets to erythrocytes (platelet-rich plasma [PLT]/red blood cell [RBC] ratio) remains unclear. We hypothesized that high PLT/RBC ratios, as compared with low PLT/RBC ratios, are associated with improved survival in patients requiring massive transfusion. METHODS Four databases (Pubmed, CINAHL, EMBASE, and Cochrane) were systematically screened for literatures published until January 21, 2021, to determine the effect of PLT/RBC ratio on the primary outcome measure mortality at 1 hour to 6 hours and 24 hours and at 28 days to 30 days. Studies comparing various PLT/RBC ratios were included in the meta-analysis. Secondary outcomes included intensive care unit length of stay and in-hospital length of stay and total blood component use. The study protocol was registered in PROSPERO under number CRD42020165648. RESULTS The search identified a total of 8903 records. After removing the duplicates and second screening of title, abstract, and full text, a total of 59 articles were included in the analysis. Of these articles, 12 were included in the meta-analysis. Mortality at 1 hour to 6 hours, 24 hours, and 28 days to 30 days was significantly lower for high PLT/RBC ratios as compared with low PLT/RBC ratios. CONCLUSION Higher PLT/RBC ratios are associated with significantly lower 1-hour to 6-hour, 24-hour, 28-day to 30-day mortalities as compared with lower PLT/RBC ratios. The optimal PLT/RBC ratio for massive transfusion in trauma patients is approximately 1:1.
Original languageEnglish
Pages (from-to)759-771
Number of pages13
JournalJournal of Trauma and Acute Care Surgery
Volume91
Issue number4
DOIs
Publication statusPublished - 1 Oct 2021

Keywords

  • Trauma
  • resuscitation
  • hemorrhage
  • platelets
  • massive transfusion protocol
  • damage-control resuscitation
  • DAMAGE CONTROL RESUSCITATION
  • RED-BLOOD-CELLS
  • RANDOMIZED OPTIMAL PLATELET
  • FRESH-FROZEN PLASMA
  • CONTROL LAPAROTOMY
  • IMPROVED SURVIVAL
  • WHOLE-BLOOD
  • EXSANGUINATION PROTOCOL
  • APHERESIS PLATELETS
  • COMPONENT THERAPY

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