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PROPHYLACTIC PLATELET THERAPY IN OPEN HEART SURGERY PATIENTS "IS UNWARRANTED"

Executive Summary

PROPHYLACTIC PLATELET THERAPY IN OPEN HEART SURGERY PATIENTS "IS UNWARRANTED" the National Institutes of Health Consensus Conference on Platelet Transfusion Therapy concluded in a draft statement issued on Oct. 8. "Controlled prospective studies examining postoperative blood loss and outcome have demonstrated no correlation between platelet counts and bleeding following cardiopulmonary bypass and no detectable benefit from the prophylactic administration of platelets to such patients," the report stated. The panel concluded that "there is no justification for prophylactic platelet administration in patients undergoing open heart surgery." The consensus panel discouraged the overuse or unnecessary use of platelets since demand for platelet concentrates exceeds supply. Panel Chairman Richard Aster, MD, Medical College of Wisconsin, noted that the number of platelet transfusions has increased from 200,000-300,000 annually in the 1970's to 5 million this year. Collins pointed out that "15% to as high as 50% of all platelet concentrates . . . go to patients who are undergoing open heart surgery." In answer to the question who should receive platelet therapy, the consensus statement concluded: "Patients with thrombocytopenia and/or an abnormality of platelet function who have significant bleeding should receive platelets if the platelet disorder is likely to be causing or contributing to the bleeding. . . A bleeding time of less than twice the upper limits of normal is usually not an indication for transfusion of platelets, unless there are other conditions that interfere with hemostasis." The statement noted that the prophylactic administration of platelets is controversial and "there is uncertainty as to the platelet levels that predispose thrombocytopenic patients to hemorrhage and as to the effectiveness of modalities other than platelets in the prevention of bleeding." However, it concluded that "the patient with severe thrombocytopenia may benefit from prophylactic administration of platelets." The statement added that "patients with chronic hypoproductive thrombocytopenia (e.g., aplastic anemia, myeloproliferative disorders) generally do not require routine platelet transfusions" and "patients with accelerated destruction but active production of platelets rarely need platelet transfusions (e.g., idiopathic thrombocytopenic purpura)." Future research proposed by the panel includes development of a practical test that predicts the likelihood of clinically significant platelet-related bleeding; controlled clinical trials to evaluate strategies for prophylactic use of platelets in patients with disorders of platelet production; and evaluation of pharmacologic approaches designed to reduce platelet requirements.

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