Platelet transfusion practice in the intensive care unit: The Nine-I international platelet transfusion survey Journal Article


Authors: Russell, L.; Azoulay, E.; Anthon, C. T.; Pène, F.; Akella, P.; Mabrouki, A.; Puxty, K.; Nielsen, L. B.; Andreasen, J. B.; Kander, T.; Sjövall, F.; Hästbacka, J.; Hvas, C. L.; Van De Louw, A.; Chawla, S.; Bauer, P. R.; Castro, P.; Povoa, P.; Coelho, L.; Fernandez, S.; Topeli, A.; Barratt-Due, A.; Barbaglio, C.; Kochanek, M.; Martin-Loeches, I.; Kentish-Barnes, N.
Article Title: Platelet transfusion practice in the intensive care unit: The Nine-I international platelet transfusion survey
Abstract: Background: Platelet transfusions are frequent in the Intensive Care Unit (ICU), either as prophylaxis against bleeding complications or as treatment for bleeding. The European Society of Intensive Care Medicine guidelines for ICU patients generally recommend not using prophylactic platelet transfusions unless the platelet count falls below 10 × 109 cells/L in non-bleeding patients and make no recommendation for platelet transfusion threshold in non-massively bleeding patients with thrombocytopenia. Therefore, the decision to transfuse platelets is often left to clinical assessment by the treating physician. This study aims to describe current platelet transfusion preferences among ICU physicians. Methods: An online, anonymous survey consisting of 43 items was produced in two languages (French and English) and distributed by investigators in the Nine-I research network to ICU physicians in Europe and the United States of America. The survey evaluated platelet transfusion practices in ICU patients with and without bleeding, the presence of local guidelines, and factors influencing the decisions to transfuse platelets. Only completed surveys were analysed. Results: We received 997 surveys completed by ICU physicians. Overall, there was large heterogeneity in platelet transfusion practices between and within countries. In non-bleeding, thrombocytopenic medical ICU patients, most would transfuse prophylactic platelets at a platelet count threshold of 10 × 109 cells/L. Thirty percent would change their strategy in patients with bone marrow failure and either be more liberal (60%; 95% Confidence Limits 0.54, 0.66), more restrictive (31%; 0.26,0.36) or seek assistance. Higher thresholds were preferred in surgical patients, prior to procedures and in patients with bleeding. Only 173 (17%; 0.15,0.19) responded that they were confident about the clinical indications every time they prescribed a platelet transfusion. As for existing guidelines, only 123 (12%; 0.10,0.15) responded that they always read them. Colleagues' attitudes and departmental culture were important influencers on transfusion practice. Conclusion: Platelet transfusion practice in the ICU is heterogeneous, both between and within countries; guidelines are often not used, and there is often uncertainty about the clinical indication. © The Author(s) 2025.
Keywords: adult; united states; clinical practice; treatment indication; thrombocytopenia; health survey; intensive care; europe; intensive care unit; prophylaxis; physician attitude; clinical practice guideline; brain hemorrhage; thrombocyte transfusion; platelet count; surgical patient; critically ill patient; bone marrow depression; critically ill; disseminated intravascular clotting; intensivist; human; male; female; article; organizational culture; medical intensive care unit; major bleeding; platelet transfusions; minor bleeding
Journal Title: Annals of Intensive Care
Volume: 15
ISSN: 2110-5820
Publisher: SpringerOpen  
Date Published: 2025-07-08
Start Page: 91
Language: English
DOI: 10.1186/s13613-025-01494-4
PROVIDER: scopus
PMCID: PMC12237844
PUBMED: 40627074
DOI/URL:
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Source: Scopus
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  1. Sanjay Chawla
    50 Chawla