Platelet Transfusion Is Associated With Increased Thrombosis and In-Hospital Mortality Among Patients Hospitalized With Platelet Consumptive Disorders.

BACKGROUND

Platelet transfusion is commonly used to reduce bleeding risk in platelet consumptive disorders. However, platelets may also promote thromboinflammatory pathways, and contemporary data evaluating the association between platelet transfusion, thrombosis, and mortality in this population are limited.

METHODS

We performed a retrospective cohort study using the National Inpatient Sample from 2018 to 2021. Non-elective hospitalizations with immune thrombocytopenic purpura, thrombotic thrombocytopenic purpura, heparin-induced thrombocytopenia, or other primary thrombocytopenias were included. The exposure was receipt of any platelet transfusion during hospitalization. Primary outcomes were in-hospital mortality and in-hospital thrombotic events, defined as venous thromboembolism or arterial thrombosis using ICD-10-CM codes. Inverse probability of treatment weighting and survey-weighted logistic regression were used to adjust for demographics, comorbidities, illness severity, major bleeding, and disease-specific therapies.

RESULTS

Among 67 405 hospitalizations (337 705 weighted national estimates), 10.5% received platelet transfusion. Mortality was higher in transfused versus nontransfused hospitalizations (9.5% vs. 6.1%; p < 0.001). After adjustment, platelet transfusion was associated with increased odds of in-hospital mortality (adjusted odds ratio [aOR], 1.42; 95% CI: 1.28-1.60) and thrombosis (any thrombosis: aOR, 1.28; 95% CI: 1.18-1.39). Associations were observed for venous (aOR, 1.39) and arterial thrombosis (aOR, 1.15). Thrombotic risk persisted among hospitalizations without major bleeding but was attenuated with major bleeding. Intravenous immunoglobulin was associated with higher odds of thrombosis, while plasma exchange was associated with lower odds.

CONCLUSION

In patients hospitalized with platelet consumptive disorders, platelet transfusion was associated with higher odds of in-hospital thrombosis and mortality, supporting judicious, indication-driven transfusion practices.