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Prophylactic platelet transfusion ineffective in dengue patients

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PHILADELPHIA — Preventive platelet transfusion treatment for patients with dengue infection did not appear to be superior to supportive care, according to late-breaker data presented here at the annual meeting of the American Society of Tropical Medicine and Hygiene.

“Hemorrhagic manifestation has been shown to be a very common risk factor for severe dengue, if not properly and promptly managed,” Junxiong V. Pang, PhD, of the Institute of Infectious Diseases and Epidemiology in Singapore and Tan Tock Seng Hospital in Singapore, said during a presentation. “While platelet replacement has been [recommended] in the context of active bleeding, the role of prophylactic platelet transfusion is still not very clear.”

From 2010 to 2014, Leo Yee-Sin, FRCP, also of the Institute of Infectious Diseases and Epidemiology in Singapore, and colleagues conducted a multicenter, open-label, randomized clinical trial comparing outcomes among 369 adult dengue patients treated at five hospitals in Singapore and Malaysia. Those eligible for enrollment had platelet counts of no more than 20x10³/μL and no major bleeding. Patients were randomly assigned to either preventive platelet transfusion (n = 187) or supportive care (n = 182), and the primary outcome was any clinical bleeding. Secondary outcomes included dengue hemorrhagic fever, severe dengue, severe bleeding, length of hospital stay, ICU admission and death.

Baseline clinical and demographic characteristics were similar between groups. Although bleeding was slightly more common among patients receiving supportive care (26.4% vs. 21.4%), this difference was not great enough to be significant (OR = 1.32; 90% CI, 0.88-1.97). In addition, mild or moderate adverse events were more frequently observed among the transfusion group, but there was no difference in severe adverse outcomes.

Bleeding of the gums was the most commonly observed, and severe cases of bleeding were uncommon. Both groups demonstrated similar rates of severe bleeding, severe dengue, clinical warning signs and median length of hospital stay throughout the study, and all patients on supportive care spontaneously recovered from low platelet counts.

“Prophylactic platelet transfusion was not effective in reducing bleeding in adult dengue patients,” Pang said. “There were also significantly more mild-to-moderate adverse events … in the transfused group as compared to the nontransfused group.” – by Dave Muoio

Reference:

Leo Y-S, et al. Abstract LB-5123. Presented at: American Society of Tropical Medicine and Hygiene Annual Meeting; Oct. 25-29, 2015; Philadelphia.

Disclosure: Pang and Sin report no relevant financial disclosures.