Prediction of bleeding and prophylactic platelet transfusions in cancer patients with thrombocytopenia

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Studies on markers for bleeding risk among thrombocytopenic cancer patients are lacking. This prospective observational cohort study investigated whether platelet parameters and a standardised bleeding questionnaire predicted bleeding or prophylactic platelet transfusions in patients with cancer and thrombocytopenia. Admitted adult patients with cancer and platelet count <80 × 10(9)/L were enrolled, but excluded if they experienced surgery or trauma within 7 days or platelet transfusion within 14 days. Patients were interviewed, blood samples collected and, subsequently, spontaneous bleeding and prophylactic platelet transfusion within 30 days were registered. Of 197 patients enrolled, 56 (28%) experienced bleeding. In multivariate analyses, predictors of bleeding were infection (adjusted odds ratio (OR) = 2.65 and 95% confidence interval (95% CI) 1.04-6.74); treatment with platelet inhibitors, heparin or warfarin OR = 2.34, 95% CI 1.23-4.48; urea nitrogen OR = 1.15, 95% CI 1.07-1.25; creatinine OR = 1.01, 95% CI 1.01-1.01; and haemoglobin OR = 0.62, 95% CI 0.41-0.93. Specific information regarding previous gastrointestinal bleeding OR = 3.33, 95% CI 1.19-9.34 and haematuria OR = 3.00, 95% CI 1.20-7.52 predicted bleeding whereas the standardised bleeding questionnaire did not. Prophylactic platelet transfusions were administered to 97 patients. Predictors of prophylactic platelet transfusions were: platelet count OR = 0.96, 95% CI 0.94-0.97; fibrinogen OR = 0.88, 95% CI 0.83-0.95; mean platelet volume OR = 0.69, 95% CI 0.49-0.97; platelet aggregometry with OR = 2.48, 95% CI 1.09-5.64 for collagen-induced platelet aggregation within the lowest quartile; and albumin OR = 1.07, 95% CI 1.01-1.15. In conclusion, except for immature platelet fraction (IPF), platelet parameters predicted prophylactic platelet transfusion but not bleeding. Bleeding risk factors were previous haematuria or gastrointestinal bleeding, infection, antiplatelet or anticoagulant treatment, high urea nitrogen, low haemoglobin or high creatinine.

Original languageEnglish
JournalPlatelets
Volume27
Issue number6
Pages (from-to)547-554
ISSN0953-7104
DOIs
Publication statusPublished - 2016

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Platelet Transfusion
Odds Ratio
Confidence Intervals
Neoplasms
Hematuria
Platelet Count
Urea
Creatinine
Nitrogen
Mean Platelet Volume
Platelet Aggregation Inhibitors
Warfarin
Platelet Aggregation
Albumins
Cohort Studies
Multivariate Analysis

Cite this

@article{f73ba9bea85c487f88f640567d12fbb8,
title = "Prediction of bleeding and prophylactic platelet transfusions in cancer patients with thrombocytopenia",
abstract = "Studies on markers for bleeding risk among thrombocytopenic cancer patients are lacking. This prospective observational cohort study investigated whether platelet parameters and a standardised bleeding questionnaire predicted bleeding or prophylactic platelet transfusions in patients with cancer and thrombocytopenia. Admitted adult patients with cancer and platelet count <80 × 10(9)/L were enrolled, but excluded if they experienced surgery or trauma within 7 days or platelet transfusion within 14 days. Patients were interviewed, blood samples collected and, subsequently, spontaneous bleeding and prophylactic platelet transfusion within 30 days were registered. Of 197 patients enrolled, 56 (28{\%}) experienced bleeding. In multivariate analyses, predictors of bleeding were infection (adjusted odds ratio (OR) = 2.65 and 95{\%} confidence interval (95{\%} CI) 1.04-6.74); treatment with platelet inhibitors, heparin or warfarin OR = 2.34, 95{\%} CI 1.23-4.48; urea nitrogen OR = 1.15, 95{\%} CI 1.07-1.25; creatinine OR = 1.01, 95{\%} CI 1.01-1.01; and haemoglobin OR = 0.62, 95{\%} CI 0.41-0.93. Specific information regarding previous gastrointestinal bleeding OR = 3.33, 95{\%} CI 1.19-9.34 and haematuria OR = 3.00, 95{\%} CI 1.20-7.52 predicted bleeding whereas the standardised bleeding questionnaire did not. Prophylactic platelet transfusions were administered to 97 patients. Predictors of prophylactic platelet transfusions were: platelet count OR = 0.96, 95{\%} CI 0.94-0.97; fibrinogen OR = 0.88, 95{\%} CI 0.83-0.95; mean platelet volume OR = 0.69, 95{\%} CI 0.49-0.97; platelet aggregometry with OR = 2.48, 95{\%} CI 1.09-5.64 for collagen-induced platelet aggregation within the lowest quartile; and albumin OR = 1.07, 95{\%} CI 1.01-1.15. In conclusion, except for immature platelet fraction (IPF), platelet parameters predicted prophylactic platelet transfusion but not bleeding. Bleeding risk factors were previous haematuria or gastrointestinal bleeding, infection, antiplatelet or anticoagulant treatment, high urea nitrogen, low haemoglobin or high creatinine.",
author = "Vinholt, {Pernille J} and Anne Alnor and Mads Nybo and Anne-Mette Hvas",
year = "2016",
doi = "10.3109/09537104.2015.1131814",
language = "English",
volume = "27",
pages = "547--554",
journal = "Platelets",
issn = "0953-7104",
publisher = "Taylor & Francis",
number = "6",

}

Prediction of bleeding and prophylactic platelet transfusions in cancer patients with thrombocytopenia. / Vinholt, Pernille J; Alnor, Anne; Nybo, Mads; Hvas, Anne-Mette.

In: Platelets, Vol. 27, No. 6, 2016, p. 547-554.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Prediction of bleeding and prophylactic platelet transfusions in cancer patients with thrombocytopenia

AU - Vinholt, Pernille J

AU - Alnor, Anne

AU - Nybo, Mads

AU - Hvas, Anne-Mette

PY - 2016

Y1 - 2016

N2 - Studies on markers for bleeding risk among thrombocytopenic cancer patients are lacking. This prospective observational cohort study investigated whether platelet parameters and a standardised bleeding questionnaire predicted bleeding or prophylactic platelet transfusions in patients with cancer and thrombocytopenia. Admitted adult patients with cancer and platelet count <80 × 10(9)/L were enrolled, but excluded if they experienced surgery or trauma within 7 days or platelet transfusion within 14 days. Patients were interviewed, blood samples collected and, subsequently, spontaneous bleeding and prophylactic platelet transfusion within 30 days were registered. Of 197 patients enrolled, 56 (28%) experienced bleeding. In multivariate analyses, predictors of bleeding were infection (adjusted odds ratio (OR) = 2.65 and 95% confidence interval (95% CI) 1.04-6.74); treatment with platelet inhibitors, heparin or warfarin OR = 2.34, 95% CI 1.23-4.48; urea nitrogen OR = 1.15, 95% CI 1.07-1.25; creatinine OR = 1.01, 95% CI 1.01-1.01; and haemoglobin OR = 0.62, 95% CI 0.41-0.93. Specific information regarding previous gastrointestinal bleeding OR = 3.33, 95% CI 1.19-9.34 and haematuria OR = 3.00, 95% CI 1.20-7.52 predicted bleeding whereas the standardised bleeding questionnaire did not. Prophylactic platelet transfusions were administered to 97 patients. Predictors of prophylactic platelet transfusions were: platelet count OR = 0.96, 95% CI 0.94-0.97; fibrinogen OR = 0.88, 95% CI 0.83-0.95; mean platelet volume OR = 0.69, 95% CI 0.49-0.97; platelet aggregometry with OR = 2.48, 95% CI 1.09-5.64 for collagen-induced platelet aggregation within the lowest quartile; and albumin OR = 1.07, 95% CI 1.01-1.15. In conclusion, except for immature platelet fraction (IPF), platelet parameters predicted prophylactic platelet transfusion but not bleeding. Bleeding risk factors were previous haematuria or gastrointestinal bleeding, infection, antiplatelet or anticoagulant treatment, high urea nitrogen, low haemoglobin or high creatinine.

AB - Studies on markers for bleeding risk among thrombocytopenic cancer patients are lacking. This prospective observational cohort study investigated whether platelet parameters and a standardised bleeding questionnaire predicted bleeding or prophylactic platelet transfusions in patients with cancer and thrombocytopenia. Admitted adult patients with cancer and platelet count <80 × 10(9)/L were enrolled, but excluded if they experienced surgery or trauma within 7 days or platelet transfusion within 14 days. Patients were interviewed, blood samples collected and, subsequently, spontaneous bleeding and prophylactic platelet transfusion within 30 days were registered. Of 197 patients enrolled, 56 (28%) experienced bleeding. In multivariate analyses, predictors of bleeding were infection (adjusted odds ratio (OR) = 2.65 and 95% confidence interval (95% CI) 1.04-6.74); treatment with platelet inhibitors, heparin or warfarin OR = 2.34, 95% CI 1.23-4.48; urea nitrogen OR = 1.15, 95% CI 1.07-1.25; creatinine OR = 1.01, 95% CI 1.01-1.01; and haemoglobin OR = 0.62, 95% CI 0.41-0.93. Specific information regarding previous gastrointestinal bleeding OR = 3.33, 95% CI 1.19-9.34 and haematuria OR = 3.00, 95% CI 1.20-7.52 predicted bleeding whereas the standardised bleeding questionnaire did not. Prophylactic platelet transfusions were administered to 97 patients. Predictors of prophylactic platelet transfusions were: platelet count OR = 0.96, 95% CI 0.94-0.97; fibrinogen OR = 0.88, 95% CI 0.83-0.95; mean platelet volume OR = 0.69, 95% CI 0.49-0.97; platelet aggregometry with OR = 2.48, 95% CI 1.09-5.64 for collagen-induced platelet aggregation within the lowest quartile; and albumin OR = 1.07, 95% CI 1.01-1.15. In conclusion, except for immature platelet fraction (IPF), platelet parameters predicted prophylactic platelet transfusion but not bleeding. Bleeding risk factors were previous haematuria or gastrointestinal bleeding, infection, antiplatelet or anticoagulant treatment, high urea nitrogen, low haemoglobin or high creatinine.

U2 - 10.3109/09537104.2015.1131814

DO - 10.3109/09537104.2015.1131814

M3 - Journal article

VL - 27

SP - 547

EP - 554

JO - Platelets

JF - Platelets

SN - 0953-7104

IS - 6

ER -