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New Guidelines for Platelet Transfusions in Adults
Clinical question: What is the recommended approach to platelet transfusion in several common clinical scenarios?
Background: The AABB (formerly American Association of Blood Banks) developed these guidelines from a recent systematic review on platelet transfusion.
Synopsis: One strong recommendation was made based on moderate-quality evidence. Four weak or uncertain recommendations were made based on low- or very low-quality evidence.
For hospitalized patients with therapy-induced hypoproliferative thrombocytopenia, transfusion of up to a single unit of platelets is recommended for a platelet count of 10x109 cells/L or less to reduce the risk of spontaneous bleeding (strong recommendation, moderate-quality evidence).
For patients undergoing elective central venous catheter placement, platelet transfusion is recommended for a platelet count of less than 20x109 cells/L (weak recommendation, low-quality evidence).
For patients undergoing elective diagnostic lumbar puncture, platelet transfusion is recommended for a platelet count of less than 50x109 cells/L (weak recommendation, very low-quality evidence).
For patients undergoing major elective non-neuraxial surgery, platelet transfusion is recommended for a platelet count of less than 50x109 cells/L (weak recommendation, very low-quality evidence).
For patients undergoing cardiopulmonary bypass surgery, it is recommended that surgeons not perform routine transfusion of platelets in non-thrombocytopenic patients. For patients who have peri-operative bleeding with thrombocytopenia and/or evidence of platelet dysfunction, platelet transfusion is recommended (weak recommendation, very low-quality evidence).
There is insufficient evidence to recommend for or against platelet transfusion in patients with intracranial hemorrhage who are taking antiplatelet medications (uncertain recommendation, very low-quality evidence).
Clinical question: What is the recommended approach to platelet transfusion in several common clinical scenarios?
Background: The AABB (formerly American Association of Blood Banks) developed these guidelines from a recent systematic review on platelet transfusion.
Synopsis: One strong recommendation was made based on moderate-quality evidence. Four weak or uncertain recommendations were made based on low- or very low-quality evidence.
For hospitalized patients with therapy-induced hypoproliferative thrombocytopenia, transfusion of up to a single unit of platelets is recommended for a platelet count of 10x109 cells/L or less to reduce the risk of spontaneous bleeding (strong recommendation, moderate-quality evidence).
For patients undergoing elective central venous catheter placement, platelet transfusion is recommended for a platelet count of less than 20x109 cells/L (weak recommendation, low-quality evidence).
For patients undergoing elective diagnostic lumbar puncture, platelet transfusion is recommended for a platelet count of less than 50x109 cells/L (weak recommendation, very low-quality evidence).
For patients undergoing major elective non-neuraxial surgery, platelet transfusion is recommended for a platelet count of less than 50x109 cells/L (weak recommendation, very low-quality evidence).
For patients undergoing cardiopulmonary bypass surgery, it is recommended that surgeons not perform routine transfusion of platelets in non-thrombocytopenic patients. For patients who have peri-operative bleeding with thrombocytopenia and/or evidence of platelet dysfunction, platelet transfusion is recommended (weak recommendation, very low-quality evidence).
There is insufficient evidence to recommend for or against platelet transfusion in patients with intracranial hemorrhage who are taking antiplatelet medications (uncertain recommendation, very low-quality evidence).
Clinical question: What is the recommended approach to platelet transfusion in several common clinical scenarios?
Background: The AABB (formerly American Association of Blood Banks) developed these guidelines from a recent systematic review on platelet transfusion.
Synopsis: One strong recommendation was made based on moderate-quality evidence. Four weak or uncertain recommendations were made based on low- or very low-quality evidence.
For hospitalized patients with therapy-induced hypoproliferative thrombocytopenia, transfusion of up to a single unit of platelets is recommended for a platelet count of 10x109 cells/L or less to reduce the risk of spontaneous bleeding (strong recommendation, moderate-quality evidence).
For patients undergoing elective central venous catheter placement, platelet transfusion is recommended for a platelet count of less than 20x109 cells/L (weak recommendation, low-quality evidence).
For patients undergoing elective diagnostic lumbar puncture, platelet transfusion is recommended for a platelet count of less than 50x109 cells/L (weak recommendation, very low-quality evidence).
For patients undergoing major elective non-neuraxial surgery, platelet transfusion is recommended for a platelet count of less than 50x109 cells/L (weak recommendation, very low-quality evidence).
For patients undergoing cardiopulmonary bypass surgery, it is recommended that surgeons not perform routine transfusion of platelets in non-thrombocytopenic patients. For patients who have peri-operative bleeding with thrombocytopenia and/or evidence of platelet dysfunction, platelet transfusion is recommended (weak recommendation, very low-quality evidence).
There is insufficient evidence to recommend for or against platelet transfusion in patients with intracranial hemorrhage who are taking antiplatelet medications (uncertain recommendation, very low-quality evidence).
Shorter Treatment for Vertebral Osteomyelitis May Be as Effective as Longer Treatment
Clinical question: Is a six-week regimen of antibiotics as effective as a 12-week regimen in the treatment of vertebral osteomyelitis?
Background: The optimal duration of antibiotic treatment for vertebral osteomyelitis is unknown. Previous guidelines recommending six to 12 weeks of therapy have been based on expert opinion rather than clinical trial data.
Study design: Multi-center, open-label, randomized controlled trial.
Setting: Seventy-one medical care centers in France.
Synopsis: Three hundred fifty-six adult patients with culture-proven bacterial vertebral osteomyelitis were randomized to six- or 12- week antibiotic treatment regimens. The primary outcome was confirmed cure of infection at 12 months, as defined by absence of pain, fever, and CRP <10 mg/L. Outcomes were determined by a blinded panel of physicians.
Results showed 90.9% of the patients in the six-week group, and 90.8% of the patients in the 12-week group, met criteria for clinical cure. The lower bound of the 95% confidence interval for the difference in percentages of cure between groups was -6.2%, satisfying the predetermined noninferiority margin of 10%.
Antibiotic therapy in this trial was governed by French guidelines, which recommend oral fluoroquinolones and rifampin as first-line agents for vertebral osteomyelitis. Median duration of IV antibiotic therapy was less than 14 days. Relatively few patients had abscesses, and only eight of the 145 patients with Staphylococcus aureus (SA) infections had methicillin-resistant SA (MRSA).
Bottom line: A six-week regimen of antibiotics was shown to be noninferior to a 12-week regimen for treatment of vertebral osteomyelitis. Treatment for longer than six weeks may be indicated in the setting of drug-resistant organisms, extensive bone destruction, or abscesses.
Clinical question: Is a six-week regimen of antibiotics as effective as a 12-week regimen in the treatment of vertebral osteomyelitis?
Background: The optimal duration of antibiotic treatment for vertebral osteomyelitis is unknown. Previous guidelines recommending six to 12 weeks of therapy have been based on expert opinion rather than clinical trial data.
Study design: Multi-center, open-label, randomized controlled trial.
Setting: Seventy-one medical care centers in France.
Synopsis: Three hundred fifty-six adult patients with culture-proven bacterial vertebral osteomyelitis were randomized to six- or 12- week antibiotic treatment regimens. The primary outcome was confirmed cure of infection at 12 months, as defined by absence of pain, fever, and CRP <10 mg/L. Outcomes were determined by a blinded panel of physicians.
Results showed 90.9% of the patients in the six-week group, and 90.8% of the patients in the 12-week group, met criteria for clinical cure. The lower bound of the 95% confidence interval for the difference in percentages of cure between groups was -6.2%, satisfying the predetermined noninferiority margin of 10%.
Antibiotic therapy in this trial was governed by French guidelines, which recommend oral fluoroquinolones and rifampin as first-line agents for vertebral osteomyelitis. Median duration of IV antibiotic therapy was less than 14 days. Relatively few patients had abscesses, and only eight of the 145 patients with Staphylococcus aureus (SA) infections had methicillin-resistant SA (MRSA).
Bottom line: A six-week regimen of antibiotics was shown to be noninferior to a 12-week regimen for treatment of vertebral osteomyelitis. Treatment for longer than six weeks may be indicated in the setting of drug-resistant organisms, extensive bone destruction, or abscesses.
Clinical question: Is a six-week regimen of antibiotics as effective as a 12-week regimen in the treatment of vertebral osteomyelitis?
Background: The optimal duration of antibiotic treatment for vertebral osteomyelitis is unknown. Previous guidelines recommending six to 12 weeks of therapy have been based on expert opinion rather than clinical trial data.
Study design: Multi-center, open-label, randomized controlled trial.
Setting: Seventy-one medical care centers in France.
Synopsis: Three hundred fifty-six adult patients with culture-proven bacterial vertebral osteomyelitis were randomized to six- or 12- week antibiotic treatment regimens. The primary outcome was confirmed cure of infection at 12 months, as defined by absence of pain, fever, and CRP <10 mg/L. Outcomes were determined by a blinded panel of physicians.
Results showed 90.9% of the patients in the six-week group, and 90.8% of the patients in the 12-week group, met criteria for clinical cure. The lower bound of the 95% confidence interval for the difference in percentages of cure between groups was -6.2%, satisfying the predetermined noninferiority margin of 10%.
Antibiotic therapy in this trial was governed by French guidelines, which recommend oral fluoroquinolones and rifampin as first-line agents for vertebral osteomyelitis. Median duration of IV antibiotic therapy was less than 14 days. Relatively few patients had abscesses, and only eight of the 145 patients with Staphylococcus aureus (SA) infections had methicillin-resistant SA (MRSA).
Bottom line: A six-week regimen of antibiotics was shown to be noninferior to a 12-week regimen for treatment of vertebral osteomyelitis. Treatment for longer than six weeks may be indicated in the setting of drug-resistant organisms, extensive bone destruction, or abscesses.