The influence of bleeding on trigger changes for platelet transfusion in patients with chemotherapy-induced thrombocytopenia

BACKGROUND: For patients with thrombocytopenia without bleeding risk factors, a platelet transfusion trigger of 10x109/L is recommended. No studies have evaluated the clinicians' decision-making process leading to trigger changes. STUDY DESIGN AND METHODS: We report on the evaluation of trigger changes and the relation with bleeding. Eighty patients previously enrolled in the SPRINT trial represent the patient population for the current analysis. RESULTS: Seventy-four patients had a starting trigger of 10x109/L. Only a minority of patients treated with chemotherapy alone (3/12, 25%) and autologous transplant (6/15, 40%) had a change in their trigger in contrast to the majority of allogeneic transplant (37/47, 79%; p=0.001 and p=0.009, respectively, when compared to allogeneic transplant group). Bleeding was the main reason reported by clinicians for a trigger change, but the occurrence of significant bleeding (Grade 2-4) was similar in patients with or without a trigger change (51 and 54%, p=1.00). Clinicians were influenced by the bleeding system: Grade 1 mucocutaneous bleeding leading to a trigger change was overrepresented (71% of cases), as was Grade 2 genitourinary bleeding not leading to a trigger change (57% of cases). CONCLUSION: A universal trigger of 10x109/L may not be maintained in a diverse population of patients with their respective bleeding risk factors. Because the trigger is changed often, it may not be as effective as previously believed.