Platelet Transfusion in Critically Ill Patients With Thrombocytopenia

Overview

Thrombocytopenia is a common biological disorder in critically ill patients. The main supportive treatment is platelet transfusion with the aim of preventing and treating bleeding and securing invasive procedures. Current guidelines suggest that prophylactic platelet transfusion should probably be administered in non-bleeding critically ill patients at platelet count triggers of 10 to 20 G/L, albeit with very low certainty since extrapolated from studies carried out in stable patients with hematological malignancies. Indications for prophylactic platelet transfusion have not been properly addressed in adult ICU patients with regard to their particular risk of bleeding and prognosis. We propose the TRAMPOLINE study in order to address two different platelet count thresholds of 10 G/L (low threshold) or 20 G/L (high threshold) for the prevention of ICU-acquired bleeding in critically ill patients with severe thrombocytopenia.

Interventions

• Other Platelet transfusion if platelet count ≤ 10 G/L
  Platelet transfusion as soon as platelet count falls ≤ 10 G/L
• Other Platelet transfusion when platelet count ≤ 20 G/L
  Platelet transfusion will be initiated immediately after randomisation

Primary outcome measures

• Incidence of ICU-acquired severe and debilitating bleeding [Time frame: Until ICU discharge or up to 28 days in ICU]

Secondary outcome measures (12)

• Incidence of ICU-acquired mild bleeding [Time frame: Until ICU discharge or at 28 days in ICU]
• Incidence of ICU-acquired mild to debilitating bleeding [Time frame: Until ICU discharge or up to 28 days in ICU]
• Total number of platelet transfusions episodes [Time frame: Until ICU discharge or up to 28 days in ICU]
• Number of prophylactic platelet transfusions episodes [Time frame: Until ICU discharge or up to 28 days in ICU]
• Doses of transfused platelets [Time frame: Until ICU discharge or up to 28 days in ICU]
• Number of packed red cell transfusions [Time frame: Until ICU discharge or up to 28 days in ICU]
• Volumes of packed red cell transfusions [Time frame: Until ICU discharge or up to 28 days in ICU]
• Volumes of fresh frozen plasma [Time frame: Until ICU discharge or up to 28 days in ICU]
• Incidence of ICU-acquired infections [Time frame: Up to 72 hours after ICU discharge]
• Incidence of acquired arterial thrombotic events [Time frame: Up to 72 hours after ICU discharge]
• Incidence of acquired venous thrombotic events [Time frame: Up to 72 hours after ICU discharge]
• Incidence of Central Venous Catheter (CVC)-related hemorrhagic and infectious complications [Time frame: Up to 72 hours after ICU discharge]

Eligibility criteria

Inclusion criteria

• Age ≥ 18 y.o. AND
• Hospitalisation in the ICU with at least one of the following life support during the current ICU stay (past or ongoing, regardless of indications)

• circulatory support (inotropes/ vasopressors at any dose)
• respiratory support (invasive mechanical ventilation, non-invasive ventilation, continuous positive airway pressure (CPAP), high-flow nasal oxygen, O2 supply ≥ 6 L/min)
• renal replacement therapy for metabolic disturbances and/or acute and acute-on chronic kidney failure (if not previously under chronic hemodialysis) AND
• Platelet count ≤ 20 G/L within the last 24h (first occurrence at any time during the ICU stay) AND
• expected ICU stay for at least 48 hours from the time of enrollment AND
• Signed consent by the patient or his/her relative, or under an emergency procedure (emergency enrollment notified in the medical file, with requirement for confirmation consent a posteriori)

Exclusion criteria

• Major bleeding (WHO grade 3-4) or mild bleeding (WHO grade 2) within the present hospitalization
• Major surgery within the recent 72 hours
• Intracranial or retinal bleeding within the recent 7 days
• Non- or contra-indication to prophylactic platelet transfusion (immune thrombocytopenia, thrombotic microangiopathy)
• Indications for increased prophylactic platelet transfusion threshold \> 20 G/L (conditions associated with increased risk of bleeding including, but not limited to extra-corporeal membrane oxygenation, therapeutic anticoagulant treatment, fibrinolysis…)
• Known full refractory status to platelet transfusion (prophylactic transfusion not recommended)
• Prophylactic platelet transfusion already applied at platelet count ≤ 20 G/L during the present ICU stay
• Patient opposed to transfusion of blood products
• Moribund patients (death expected within the next 24 hours)
• Pregnancy/breastfeeding
• Not covered by French Social Security (health insurance)
• Patient under safeguarding of justice

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Prevention

Study locations

Center list to be confirmed — check the primary protocol.

Identifiers

NCT: NCT06599385 · APHP230835

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗