Analysis of bleeding outcomes in patients with hypoproliferative thrombocytopenia in the A-TREAT clinical trial.

Autor: Poston JN; Division of Hematology & Oncology, Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA.; Division of Clinical Pathology, Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA., Brown SP; Department of Biostatistics, University of Washington, Seattle, Washington, USA., Ginsburg AS; Department of Biostatistics, University of Washington, Seattle, Washington, USA., Ilich A; Department of Medicine, Division of Hematology and Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA., Herren H; Department of Biostatistics, University of Washington, Seattle, Washington, USA., El Kassar N; Division of Blood Diseases and Resources, National Institutes of Health, National Heart, Lung and Blood Institute, Bethesda, Maryland, USA., Triulzi DJ; Department of Pathology, Division of Transfusion Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Key NS; Department of Medicine, Division of Hematology and Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA., May S; Department of Biostatistics, University of Washington, Seattle, Washington, USA., Gernsheimer TB; Division of Hematology & Oncology, University of Washington School of Medicine and Fred Hutchinson Cancer Center, Seattle, WA, USA.
Jazyk: angličtina
Zdroj: Transfusion [Transfusion] 2024 Nov; Vol. 64 (11), pp. 2055-2062. Date of Electronic Publication: 2024 Oct 07.
DOI: 10.1111/trf.18028
Abstrakt: Background: Despite prophylactic platelet transfusions, hypoproliferative thrombocytopenia is associated with bleeding; historical risk factors include hematocrit (HCT) ≤ 25%, activated partial thromboplastin time ≥ 30 s, international normalized ratio ≥ 1.2, and platelets ≤ 5000/μL.
Methods: We performed a post hoc analysis of bleeding outcomes and risk factors in participants with hematologic malignancy and hypoproliferative thrombocytopenia enrolled in the American Trial to Evaluate Tranexamic Acid Therapy in Thrombocytopenia (A-TREAT) and randomized to receive either tranexamic acid (TXA) or placebo.
Results: World Health Organization (WHO) grade 2+ bleeding occurred in 46% of 330 participants, with no difference between the TXA (44%) and placebo (47%) groups (p = 0.66). Overall, the most common sites of bleeding were oronasal (18%), skin (17%), gastrointestinal (11%), and genitourinary (11%). Among participants of childbearing potential, 28% experienced vaginal bleeding. Platelets ≤5000/μL and HCT < 21% (after adjusting for severe thrombocytopenia) were independently associated with increased bleeding risk (HR 3.78, 95% CI 2.16-6.61; HR 2.67, 95% CI 1.35-5.27, respectively). Allogeneic stem cell transplant was associated with nonsignificant increased risk of bleeding versus chemotherapy alone (HR 1.34, 95% CI 0.94-1.91).
Discussion: The overall rate of WHO grade 2+ bleeding was similar to previous reports, albeit with lower rates of gastrointestinal bleeding. Vaginal bleeding was common in participants of childbearing potential. Platelets ≤5000/μL remained a risk factor for bleeding. Regardless of platelet count, bleeding risk increased with HCT < 21%, suggesting a red blood cell transfusion threshold above 21% should be considered to mitigate bleeding. More investigation is needed on strategies to reduce bleeding in this population.
(© 2024 The Author(s). Transfusion published by Wiley Periodicals LLC on behalf of AABB.)
Databáze: MEDLINE
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