Alternative agents versus prophylactic platelet transfusion for preventing bleeding in patients with thrombocytopenia due to chronic bone marrow failure: a network meta-analysis and systematic review

Abstract

This is the protocol for a review and there is no abstract. The objectives are as follows: To compare the relative efficacy of different treatments for thrombocytopenia (artificial platelet substitutes, platelet-poor plasma, fibrinogen, rFVIIa, rFXIII, thrombopoietin mimetics, antifibrinolytic drugs or platelet transfusions) in patients with chronic bone marrow failure and to derive a hierarchy of potential alternate treatments to platelet transfusions.

Overview of Plasma and Platelet Transfusions in Critically Ill Children

“…The optimum platelet count threshold for transfusion is significantly variable depending on the underlying etiology, clinical practice setting, and geographic location, which needs further evaluation (72). At present, there is a lack of evidence to replace platelet transfusions with the newer platelet substitutes, such as artificial platelets, recombinant interleukin-6 or-11, and thrombopoietin mimetics (73).…”

Alternatives, and adjuncts, to prophylactic platelet transfusion for people with haematological malignancies undergoing intensive chemotherapy or stem cell transplantation

“…If subgroup data for haematological participants were not provided (after contacting the authors of the trial), we excluded trials if less than 80% of participants had a haematological disorder. We excluded any participants that were not treated with intensive chemotherapy or a stem cell transplant as these participants are the focus of another review (Desborough 2016). We included participants with non-malignant haematological disorders (e.g.…”

“…We also excluded people treated with non-intensive chemotherapy (such as azacitidine, decitabine and lenalidomide) because the degree of thrombocytopenia is much less profound with a lower risk of bleeding. Trials in people with chronic bone marrow failure using these agents are reported in another review (Desborough 2016).…”

“…Included in review of alternatives or adjuncts to platelet transfusion for people with chronic bone marrow failure (Desborough 2016) Gallardo 1983 Incorrect intervention Gerrits 2015 Not an RCT Giagounidis 2014 Wrong participant group. Included in review of alternatives or adjuncts to platelet transfusion for people with chronic bone marrow failure (Desborough 2016) Glaspy 1991 Incorrect intervention Greenberg 2013 Wrong participant group. Included in review of alternatives or adjuncts to platelet transfusion for people with chronic bone marrow failure (Desborough 2016) Hampton 2007 Review article Heddle 1995 Incorrect intervention Höchsmann 2014 Wrong participant group Jain 2013 Wrong participant group Johansson 2008 Review article Kantarjian 2010a Wrong participant group.…”

“…Included in review of alternatives or adjuncts to platelet transfusion for people with chronic bone marrow failure (Desborough 2016) Hampton 2007 Review article Heddle 1995 Incorrect intervention Höchsmann 2014 Wrong participant group Jain 2013 Wrong participant group Johansson 2008 Review article Kantarjian 2010a Wrong participant group. Included in review of alternatives or adjuncts to platelet transfusion for people with chronic bone marrow failure (Desborough 2016) Kantarjian 2010b Wrong participant group Kellum 2010 Wrong participant group Knoefler 2013 Not an RCT Korte 2009 Wrong participant group Kristensen 1993 Not an RCT Kruskemper 1966 Incorrect intervention Levy 2008 Review article Li 2012 Incorrect intervention Liesveld 2013 Not an RCT Louis 1967 Incorrect intervention Malyszko 1990 Wrong participant group Mannucci 1986 Wrong participant group. Included in review of alternatives or adjuncts to platelet transfusion for people with chronic bone marrow failure (Desborough 2016) Matsumoto 2007 Incorrect intervention Mittelman 2012 Not an RCT Mizer 1998 Review article Nair 2006 …”