S1324 Empiric Platelet Transfusion in Acute Variceal Bleeding Is Associated With Higher Mortality and Rebleeding: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Introduction: Acute variceal bleeding (AVB) is one of the leading causes of mortality in cirrhosis patients, having around a 20% mortality rate at 6 weeks. Although platelet transfusions are frequently performed to manage thrombocytopenia, they carry risks such as inflammation and fluid overload. Their efficacy associated with the transfusions is questionable. This systematic review and meta-analysis aim to assess whether providing patients with AVB platelet transfusions has any effect on mortality and rebleeding. Methods: A systematic search of PubMed, Embase, Scopus, and Cochrane Library identified cohort studies reporting mortality outcomes at 42 days or 6 weeks after empirical platelet transfusion compared to management without transfusion for Acute Variceal Bleed. Data was analyzed using RevMan 5.4. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using Mantel-Haenszel methods. Random- or fixed-effects models were applied based on heterogeneity (Higgins’ I²). Statistical significance was set at P < 0.05. Risk of bias was assessed with the Newcastle-Ottawa Scale (NOS). Results: Three retrospective (2 single-centre, one multicentre) studies met inclusion (n = 1,375; 175 transfused, 1,200 controls). Platelet transfusion was associated with significantly higher 42-day mortality: 32% vs 14% (pooled risk ratio = 4.22, 95% CI 1.34–13.35, P = 0.01). All individual study estimates favoured no transfusion. Heterogeneity was high (I² = 91%), driven mainly by a cohort in which transfusion occurred within massive-transfusion protocols; leave-one-out analysis reduced I² to 48% while the harm signal persisted (RR = 2.38, 95% CI 1.37–4.11). Biswas 2022 documented day 5/ 42 rebleeds of 14.3% → 31.9% vs 4.3% → 13.3% (propensity-matched HR 2.9) while Canakis 2020 reported failure-to-control bleeding at 5 days in 18% vs 4% with platelets. Conclusion: Existing evidence suggests that in AVB, empiric platelet transfusion gives no survival benefit and may increase short-term mortality by more than 2-fold. Results from adequately powered RCTs will need to stratify by platelet count, bleeding severity, and portal hypertensive physiology before routine platelet replacement is performed under rigidly defined criteria. Until then, targeted vasoactive medications, early endoscopic procedures, and conservative packed red blood cell will remain to be the mainstay of treatment for managing AVB.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.023 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.033 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".