Postresuscitation platelet transfusion in major trauma patients

Platelet transfusions (PLT-t) are a cornerstone of contemporary trauma resuscitation, but little is known about their use in the postresuscitation period. Our aims were to describe the utilization of PLT-t after resuscitation and examine their impact on platelet count and clinical outcomes.

Adult trauma patients admitted to critical care at a single major trauma center were included. We compared patients who received PLT-t postresuscitation (>24 h after injury) with those who did not and examined platelet increments before and after each individual PLT-t episode. Logistic regressions were constructed to examine the association between postresuscitation PLT-t and clinical outcomes.

This study included 803 injured patients, of whom 109 (14%) received at least one PLT-t after resuscitation. Overall, 30% (221/725) of all platelet units administered to the cohort were given in the postresuscitation phase, most in the first week of admission and to patients with moderate-severe thrombocytopenia. The median platelet count increment following transfusion was 19 × 10⁹/L (interquartile range 1-30), and 24% of transfusions failed to increase the platelet count within 24 h. Postresuscitation PLT-t in patients with moderate-severe thrombocytopenia was independently associated with reduced mortality (OR 0.42, p = .039) but a longer critical care length of stay among survivors (coefficient 0.35, p = .007).

Postresuscitation PLT-t is frequently administered in trauma patients. The impact on platelet counts is variable, likely attributable to differences in timing and pretransfusion platelet count. After adjusting for relevant confounders, postresuscitation PLT-t was associated with reduced mortality in this cohort.