From the Guidelines
Platelet transfusions should be prepared for by administering medications that reverse the effects of antiplatelet agents, such as platelet transfusion for patients on aspirin, clopidogrel, or other platelet inhibitors, as stated in the study by 1. In preparation for a platelet transfusion, it is essential to consider the patient's current medications, particularly antiplatelet agents. According to the study by 1, platelet transfusion may be necessary to reverse the effects of platelet inhibitors such as aspirin, clopidogrel, prasugrel, ticagrelor, and ticlodipine. The study by 1 suggests that the effectiveness of platelet transfusion in correcting the effects of antiplatelet agents depends on the type of agent and the time elapsed since the last dose. For example, platelet transfusion can correct the effects of aspirin, but higher doses of platelets may be necessary to correct the effects of thienopyridines like clopidogrel and prasugrel. Some key points to consider when preparing for a platelet transfusion include:
- The type and dose of antiplatelet agent the patient is taking
- The time elapsed since the last dose of the antiplatelet agent
- The patient's medical history and risk factors for bleeding or transfusion reactions
- The potential need for additional medications to support hemostasis, such as antifibrinolytics or desmopressin, as mentioned in the study by 1. It is crucial to individualize the approach to each patient and consider the specific circumstances surrounding the platelet transfusion. The decision to administer medications to prepare for a platelet transfusion should be based on the patient's unique needs and medical history, as well as the latest evidence-based guidelines, such as those presented in the study by 1.
From the Research
Medications for Platelet Transfusion Preparation
- The use of acetaminophen and diphenhydramine as premedication for platelet transfusions has been investigated in several studies 2, 3, 4.
- A prospective randomized double-blind placebo-controlled trial found that premedication with acetaminophen and diphenhydramine did not significantly lower the incidence of non-hemolytic transfusion reactions compared to placebo 3.
- A literature review also found that there is no evidence to support the use of premedications in minimizing transfusion-related reactions, and the practice is questioned in settings where leukoreduction is used 2.
- Another study suggested that the benefits of routine prophylaxis with acetaminophen and diphenhydramine may not outweigh their risks and cost, particularly in light of the low reaction rates reported at many institutions even when premedication is not prescribed 4.
Alternative Strategies
- Leukoreduction has been shown to be effective in minimizing febrile nonhemolytic transfusion reactions, and its use is recommended as a practice 2, 5.
- Guidelines for platelet transfusions have been published, but practices are still heterogeneous, and platelet transfusion guidelines partly lack recommendations or differ in platelet threshold recommendations in some clinical situations 6.
- The use of gamma irradiation to prevent transfusion-associated graft-versus-host disease is also discussed in the context of platelet transfusion therapy 5.