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Platelet transfusion practice in the intensive care unit : the Nine-I international platelet transfusion survey

Russell, Lene ; Azoulay, Elie ; Anthon, Carl Thomas ; Pène, Frédéric ; Akella, Padmastuti ; Mabrouki, Asma ; Puxty, Kathryn ; Nielsen, Lene Bjerregaard ; Andreasen, Jo Bønding and Kander, Thomas LU orcid , et al. (2025) In Annals of Intensive Care 15(1).
Abstract

BACKGROUND: Platelet transfusions are frequent in the Intensive Care Unit (ICU), either as prophylaxis against bleeding complications or as treatment for bleeding. The European Society of Intensive Care Medicine guidelines for ICU patients generally recommend not using prophylactic platelet transfusions unless the platelet count falls below 10 × 10 9 cells/L in non-bleeding patients and make no recommendation for platelet transfusion threshold in non-massively bleeding patients with thrombocytopenia. Therefore, the decision to transfuse platelets is often left to clinical assessment by the treating physician. This study aims to describe current platelet transfusion preferences among ICU physicians.

METHODS: An online, anonymous... (More)

BACKGROUND: Platelet transfusions are frequent in the Intensive Care Unit (ICU), either as prophylaxis against bleeding complications or as treatment for bleeding. The European Society of Intensive Care Medicine guidelines for ICU patients generally recommend not using prophylactic platelet transfusions unless the platelet count falls below 10 × 10 9 cells/L in non-bleeding patients and make no recommendation for platelet transfusion threshold in non-massively bleeding patients with thrombocytopenia. Therefore, the decision to transfuse platelets is often left to clinical assessment by the treating physician. This study aims to describe current platelet transfusion preferences among ICU physicians.

METHODS: An online, anonymous survey consisting of 43 items was produced in two languages (French and English) and distributed by investigators in the Nine-I research network to ICU physicians in Europe and the United States of America. The survey evaluated platelet transfusion practices in ICU patients with and without bleeding, the presence of local guidelines, and factors influencing the decisions to transfuse platelets. Only completed surveys were analysed.

RESULTS: We received 997 surveys completed by ICU physicians. Overall, there was large heterogeneity in platelet transfusion practices between and within countries. In non-bleeding, thrombocytopenic medical ICU patients, most would transfuse prophylactic platelets at a platelet count threshold of 10 × 10 9 cells/L. Thirty percent would change their strategy in patients with bone marrow failure and either be more liberal (60%; 95% Confidence Limits 0.54, 0.66), more restrictive (31%; 0.26,0.36) or seek assistance. Higher thresholds were preferred in surgical patients, prior to procedures and in patients with bleeding. Only 173 (17%; 0.15,0.19) responded that they were confident about the clinical indications every time they prescribed a platelet transfusion. As for existing guidelines, only 123 (12%; 0.10,0.15) responded that they always read them. Colleagues' attitudes and departmental culture were important influencers on transfusion practice.

CONCLUSION: Platelet transfusion practice in the ICU is heterogeneous, both between and within countries; guidelines are often not used, and there is often uncertainty about the clinical indication.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Annals of Intensive Care
volume
15
issue
1
article number
91
publisher
Springer Science and Business Media B.V.
external identifiers
  • pmid:40627074
ISSN
2110-5820
DOI
10.1186/s13613-025-01494-4
language
English
LU publication?
yes
additional info
© 2025. The Author(s).
id
ab49b76f-8582-4dec-ae71-d39ce8ef8f52
date added to LUP
2025-07-14 02:25:35
date last changed
2025-07-14 12:23:56
@article{ab49b76f-8582-4dec-ae71-d39ce8ef8f52,
  abstract     = {{<p>BACKGROUND: Platelet transfusions are frequent in the Intensive Care Unit (ICU), either as prophylaxis against bleeding complications or as treatment for bleeding. The European Society of Intensive Care Medicine guidelines for ICU patients generally recommend not using prophylactic platelet transfusions unless the platelet count falls below 10 × 10 9 cells/L in non-bleeding patients and make no recommendation for platelet transfusion threshold in non-massively bleeding patients with thrombocytopenia. Therefore, the decision to transfuse platelets is often left to clinical assessment by the treating physician. This study aims to describe current platelet transfusion preferences among ICU physicians. </p><p>METHODS: An online, anonymous survey consisting of 43 items was produced in two languages (French and English) and distributed by investigators in the Nine-I research network to ICU physicians in Europe and the United States of America. The survey evaluated platelet transfusion practices in ICU patients with and without bleeding, the presence of local guidelines, and factors influencing the decisions to transfuse platelets. Only completed surveys were analysed.</p><p>RESULTS: We received 997 surveys completed by ICU physicians. Overall, there was large heterogeneity in platelet transfusion practices between and within countries. In non-bleeding, thrombocytopenic medical ICU patients, most would transfuse prophylactic platelets at a platelet count threshold of 10 × 10 9 cells/L. Thirty percent would change their strategy in patients with bone marrow failure and either be more liberal (60%; 95% Confidence Limits 0.54, 0.66), more restrictive (31%; 0.26,0.36) or seek assistance. Higher thresholds were preferred in surgical patients, prior to procedures and in patients with bleeding. Only 173 (17%; 0.15,0.19) responded that they were confident about the clinical indications every time they prescribed a platelet transfusion. As for existing guidelines, only 123 (12%; 0.10,0.15) responded that they always read them. Colleagues' attitudes and departmental culture were important influencers on transfusion practice. </p><p>CONCLUSION: Platelet transfusion practice in the ICU is heterogeneous, both between and within countries; guidelines are often not used, and there is often uncertainty about the clinical indication.</p>}},
  author       = {{Russell, Lene and Azoulay, Elie and Anthon, Carl Thomas and Pène, Frédéric and Akella, Padmastuti and Mabrouki, Asma and Puxty, Kathryn and Nielsen, Lene Bjerregaard and Andreasen, Jo Bønding and Kander, Thomas and Sjövall, Fredrik and Hästbacka, Johanna and Hvas, Christine Lodberg and Van De Louw, Andry and Chawla, Sanjay and Bauer, Philippe R and Castro, Pedro and Povoa, Pedro and Coelho, Luis and Fernandez, Sara and Topeli, Arzu and Barratt-Due, Andreas and Barbaglio, Caterina and Kochanek, Matthias and Martin-Loeches, Ignacio and Kentish-Barnes, Nancy}},
  issn         = {{2110-5820}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{1}},
  publisher    = {{Springer Science and Business Media B.V.}},
  series       = {{Annals of Intensive Care}},
  title        = {{Platelet transfusion practice in the intensive care unit : the Nine-I international platelet transfusion survey}},
  url          = {{http://dx.doi.org/10.1186/s13613-025-01494-4}},
  doi          = {{10.1186/s13613-025-01494-4}},
  volume       = {{15}},
  year         = {{2025}},
}