Use of Low-Dose Platelets in Actively Bleeding Patients A Retrospective Analysis of a Cardiac Surgery Cohort

Context.—During platelet shortages, many hospitals produce low-dose platelets by splitting a standard platelet unit (>3 3 10¹¹ platelets in the United States) in 2, then providing these low-dose units to patients. While low-dose units were previously found to be effective for prophylactic purposes in patients undergoing chemotherapy in the Prophylactic Platelet Dose (PLADO) trial, their use in actively bleeding patients has not yet been assessed. Objective.—To assess the use and safety of low-dose platelets in actively bleeding patients. Design.—We performed a retrospective review of cardiac surgery cases receiving platelet units for 18 months at 1 hospital. Two cohorts, those receiving only whole-dose platelets (37 cases) and those receiving only low-dose platelets (38 cases), were compared during the intraoperative and the 24-hour perioperative periods. Mean number of platelet transfusions, dose of other blood products, estimated blood loss, bleeding complications in index cases, and all-cause mortality within 30 days of discharge were compared. Results.—There was no significant difference in mean number of intraoperative platelet transfusions between the cohorts (1.61 versus 1.53, P ¼ .57). There was no significant increase in the transfusion of other blood products, estimated blood loss, bleeding complications in index cases, or all-cause mortality within 30 days of discharge in the low-dose platelet cohort, apart from a small increase in the requirement for fresh frozen plasma in the perioperative period. Conclusions.—These results suggest that low-dose platelets are tentatively equivalent to whole-dose platelets in cardiac surgery during shortages, with similar transfusion requirements and clinical outcomes between groups. Future multicenter studies are needed to confirm these findings.