The Influence of Bleeding on Trigger Changes for Platelet Transfusion in Chemotherapy-Induced Thrombocytopenic Patients
Notice bibliographique
Résumé
Abstract Abstract 1260 The optimal threshold for prophylactic platelet transfusion in hypoproliferative thrombocytopenic patients has been evaluated in multiple studies involving hematology and oncology patients. For patients without additional risk factors for bleeding, a trigger of 10 × 109/L is now accepted as safe and recommended in different guidelines. In the original studies, platelet transfusion above this trigger was allowed according to variable predetermined risk factors for bleeding. But, no studies have evaluated the clinicians' decision-making process leading to a change in the trigger for platelet transfusion. We report on the evaluation of trigger change for platelet transfusion following an initial threshold of 10 × 109/L and the relation with the presence of bleeding according to WHO grades and systems. Eighty-patients that were enrolled at University of Minnesota Medical Center for the previously published SPRINT Trial represent the patient population for the current analysis. Seventy-four patients (93%) had a starting trigger for platelet transfusion of 10 × 109/L and the majority (46/74; 62%) had an increase in their trigger during their hospitalization. Adherence to this starting trigger varied widely between treatment groups. Only a minority of patients treated with chemotherapy alone (3/12; 25%) and autologous transplant (6/15; 40%) had a change in their initial trigger of 10 × 109/L in contrast to the majority of allogeneic transplant patients (37/47; 79%) (p=0.001 compared to chemotherapy group and p=0.009 compared to autologous transplant group, respectively). The main reason reported by clinicians for a change after a starting trigger of 10 × 109/L was bleeding (32/46; 70%). However, trigger changes were not associated with more clinically significant bleeding. The occurrence of WHO grade 2–4 bleeding was very similar in patients with a trigger change and patients without a trigger change (51% and 54%; p=1.00). Even when limiting the analysis to trigger changes for a bleeding reason the overall distribution of the highest bleeding grades (WHO grade 0–4) leading to that change was similar to the highest bleeding grades of patients without a trigger change (p=0.205). Clinicians were influenced by the WHO organ system in which bleeding occurred when making their decision whether or not to raise the trigger for platelet transfusion. There was an overrepresentation of grade 1 mucocutaneous bleeding leading to an increase in the trigger (62% of the cases). And, there was an overrepresentation of grade 2 genitourinary bleeding not leading to an increase in the trigger (57% of cases). In conclusion, having a universal trigger of 10 × 109/L for platelet transfusion in hypoproliferative thrombocytopenic patients is probably not adequate because of the diversity of the patient population and their respective bleeding risk factors. Also, these multiple complicating factors for bleeding that lead to trigger changes need better validation to support clinicians in their decision-making process when addressing the optimal trigger for platelet transfusion. Otherwise, a seemingly valid trigger of 10 × 109/L becomes useless if misused or changed for any kind of reasons. Disclosures: No relevant conflicts of interest to declare.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».