Are Prophylactic Platelets Beneficial?

In a plenary session on Sunday, December 9, 2012, Dr. Simon Stanworth reported on a trial of 600 patients being treated for hematologic malignancies, chemotherapy, or stem cell transplants,  Stanworth SJ, Estcourt L,  Powter G, et al. The effect of a no-prophylactic versus prophylactic platelet transfusion strategy on bleeding in patients with hematological malignancies and severe thrombocytopenia (TOPPS trial). A randomized controlled, non-Inferiority trial. In the US, just over two million units of platelet concentrate are given per year at an approximate cost of $1000 per unit. About 2/3 are given prophylactically, 1/3 are used to treat current bleeding. Half of the no-prophylaxis arm experienced no bleeding, compared to 43% of the prophylaxis arm, indicating that many patients are transfused unnecessarily. New trials that provide risk stratification will be coming next.