Platelet to erythrocyte transfusion ratio and mortality in massively transfused trauma patients: A systematic review and meta-analysis

Tim W.H. Rijnhout*, Jeanette Duijst, Femke Noorman, Margreet Zoodsma, Oscar J.F. Van Waes, Michael H.J. Verhofstad, Rigo Hoencamp

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

2 Citations (Scopus)

Abstract

BACKGROUND: Platelet transfusion during major hemorrhage is important and often embedded in massive transfusion protocols. However, the optimal ratio of platelets to erythrocytes (platelet-rich plasma [PLT]/red blood cell [RBC] ratio) remains unclear. We hypothesized that high PLT/RBC ratios, as compared with low PLT/RBC ratios, are associated with improved survival in patients requiring massive transfusion.

METHODS: Four databases (Pubmed, CINAHL, EMBASE, and Cochrane) were systematically screened for literatures published until January 21, 2021, to determine the effect of PLT/RBC ratio on the primary outcome measure mortality at 1 hour to 6 hours and 24 hours and at 28 days to 30 days. Studies comparing various PLT/RBC ratios were included in the meta-analysis. Secondary outcomes included intensive care unit length of stay and in-hospital length of stay and total blood component use. The study protocol was registered in PROSPERO under number CRD42020165648.

RESULTS: The search identified a total of 8903 records. After removing the duplicates and second screening of title, abstract, and full text, a total of 59 articles were included in the analysis. Of these articles, 12 were included in the meta-analysis. Mortality at 1 hour to 6 hours, 24 hours, and 28 days to 30 days was significantly lower for high PLT/RBC ratios as compared with low PLT/RBC ratios.

CONCLUSION: Higher PLT/RBC ratios are associated with significantly lower 1-hour to 6-hour, 24-hour, 28-day to 30-day mortalities as compared with lower PLT/RBC ratios. The optimal PLT/RBC ratio for massive transfusion in trauma patients is approximately 1:1.

LEVEL OF EVIDENCE: Systematic review and meta-analysis, therapeutic Level III.

Original languageEnglish
Pages (from-to)759-771
Number of pages13
JournalJournal of Trauma and Acute Care Surgery
Volume91
Issue number4
DOIs
Publication statusPublished - Oct 2021

Bibliographical note

Funding Information:
This study was supported by the Dutch Department of Defense and the Dutch Army Health Insurance Foundation (SZVK). DISCLOSURE

Publisher Copyright:
© 2021 Wolters Kluwer Health, Inc. All rights reserved.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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