Prophylactic and therapeutic interventions for bleeding in dengue: a systematic review

Rajapakse, Senaka; Silva, Nipun Lakshitha de; Weeratunga, Praveen; Rodrigo, Chaturaka; Fernando, Sumadhya Deepika

doi:10.1093/trstmh/trx079

Cited by 32 publications

(26 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Lastly, the majority of participants agreed that, “need for blood transfusion” meant need for whole blood or packed red blood cells. This is important as studies have found that prophylactic platelet transfusions are not uncommonly given to dengue patients [ 80 – 82 ]. In addition, the sentiment among many participants was if fresh frozen plasma, platelets or factor concentrates were given without whole blood or packed red blood cells, then it was unlikely that the bleeding was clinically severe.…”

Section: Discussionmentioning

confidence: 99%

Development of standard clinical endpoints for use in dengue interventional trials

et al. 2018

View full text Add to dashboard Cite

Dengue is a major public health problem worldwide. Although several drug candidates have been evaluated in randomized controlled trials, none has been effective and at present, early recognition of severe dengue and timely supportive care are used to reduce mortality. While the first dengue vaccine was recently licensed, and several other candidates are in late stage clinical trials, future decisions regarding widespread deployment of vaccines and/or therapeutics will require evidence of product safety, efficacy and effectiveness. Standard, quantifiable clinical endpoints are needed to ensure reproducibility and comparability of research findings. To address this need, we established a working group of dengue researchers and public health specialists to develop standardized endpoints and work towards consensus opinion on those endpoints. After discussion at two working group meetings and presentations at international conferences, a Delphi methodology-based query was used to finalize and operationalize the clinical endpoints. Participants were asked to select the best endpoints from proposed definitions or offer revised/new definitions, and to indicate whether contributing items should be designated as optional or required. After the third round of inquiry, 70% or greater agreement was reached on moderate and severe plasma leakage, moderate and severe bleeding, acute hepatitis and acute liver failure, and moderate and severe neurologic disease. There was less agreement regarding moderate and severe thrombocytopenia and moderate and severe myocarditis. Notably, 68% of participants agreed that a 50,000 to 20,000 mm3 platelet range be used to define moderate thrombocytopenia; however, they remained divided on whether a rapid decreasing trend or one platelet count should be case defining. While at least 70% agreement was reached on most endpoints, the process identified areas for further evaluation and standardization within the context of ongoing clinical studies. These endpoints can be used to harmonize data collection and improve comparability between dengue clinical trials.

show abstract

Section: Discussionmentioning

confidence: 99%

Development of standard clinical endpoints for use in dengue interventional trials

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Thus, for years, prophylactic platelet transfusion has been performed in many cases in an attempt to reduce this risk. In recent years, several studies have demonstrated the importance of not using prophylactic blood components, especially platelets [7, 24, 28, 34–36, 38] because they were not superior to supportive care in preventing bleeding and had a higher incidence of side effects [11, 24, 37, 39].…”

Section: Discussionmentioning

confidence: 99%

“…There is no agreement about the use of blood or blood component to dengue clinical management [24]. However, in this research the WHO/PAHO recommendations for the use of blood components are the criteria used for transfusion.…”

Section: Methodsmentioning

confidence: 99%

Safety and costs of blood transfusion practices in dengue cases in Brazil

et al. 2019

View full text Add to dashboard Cite

Background Dengue is a public health problem, and noncompliance with World Health Organization (WHO) recommendations for blood transfusion components is frequently reported. Moreover, economic impact studies of the WHO recommendations on the use of blood transfusion are scarce. Methods We compared the cost and hospitalization time in a prospective observational study, by following hospitalised patients and analysing their medical records from 2010 and March 2016 to December 2017. We divided the patients into two groups: transfused (with or without WHO criteria for transfusion) and not transfused (with or without WHO criteria for transfusion). Generalised linear modelling was performed to identify the variable that could increase the costs and hospital stay. Results Among 323 patients, 52 were transfused, of whom 52% without criteria (n = 27), and 271 were not transfused, of which 4.4% (n = 12) with criteria. Hospitalisation costs were 41% higher in the transfused group without criteria than in those with criteria (median US$ 674.3 vs US$ 478 p = 0.293). Patients who were not transfused but met the WHO criteria for transfusion (n = 12) had longer mean hospitalisation time than did those who were not transfused (3.8±3.4 days versus 3.6±3.1 days; p = 0.022). The GLM analysis using hospital stay and costs as the dependent variable explained approximately 33.4% (R 2 = 0.334) of the hospitalisation time and 79.3% (R 2 = 0.793) of costs. Receiving a transfusion increased the hospitalization time by 1.29 days (p = 0.0007; IRR = 1.29), and the costs were 5.1 times higher than those without receiving blood components (IRR = 5.1; p< 0.001; median US$ 504.4 vs US$ 170.7). In contrast, patients who were transfused according to WHO criteria had a reduction in costs of approximately 96% (IRR = 0.044; p<0.001; β = -3.12) compared to that for those who were not transfused according to WHO criteria (without criteria). Conclusion Transfusion without following WHO recommendations increased the time and cost of hospitalisation.

show abstract

“…Eine Flüssigkeitsüberladung sollte zwingend vermieden werden, da hierdurch weitere Komplikationen wie ein Lungenödem entstehen können [53]. Bei hämorrhagischen Komplikationen werden Flüssigkeit nach Hämodynamik und Hämatokrit appliziert, zusätzlich werden Erythrozyten, Thrombozyten und Plasmabestandteile nach Bedarf substituiert [54]. Abhängig vom Stadium der Erkrankung können sowohl Hypo-als auch Hyperglykämien auftreten, die entsprechend leitliniengerecht behandelt werden [55].…”

Section: Epidemiologieunclassified