Patient outcomes and amotosalen/UVA-treated platelet utilization in massively transfused patients

Vox Sang. 2017 Apr;112(3):249-256. doi: 10.1111/vox.12489. Epub 2017 Feb 15.

Abstract

Background: Amotosalen/UVA-treated platelet concentrates (PCs) have demonstrated efficacy for treating and preventing bleeding in clinical trials and in routine use; however, most studies were performed in haematology/oncology patients. We investigated efficacy during massive transfusion (MT) in general hospitalized patients.

Methods: Universal amotosalen/UVA treatment (INTERCEPT Blood System) of platelets was introduced at a large Austrian medical centre. We performed a retrospective cohort analysis comparing component use, in-hospital mortality and length of stay after MT that included platelet transfusion, for two periods (21 months each) before and after implementation.

Results: A total of 306 patients had MT. Patients were mostly male (74%) and ≥18 years old (99%), including 93 liver transplant, 97 cardiac or vascular surgery and 51 trauma patients. There were no differences in demographics between the periods. Component use on the day and within 7 days of the MT event was unchanged post-IBS implementation, except trauma patients received fewer RBCs on the day. The mean ratio of RBC:platelets:plasma on the day of the MT was close to 1:1:1 in both periods, except for liver transplants with MT who received more plasma components. Overall, in-hospital mortality (preimplementation = 27·6% vs. postimplementation = 24·0%; P = 0·51) and median time to discharge (preimplementation = 27 vs. postimplementation = 23 days; P = 0·37) did not change, except for cardiac and vascular surgery patients who were discharged earlier.

Conclusion: The introduction of amotosalen/UVA-treated, pathogen-reduced PC did not adversely affect clinical outcomes in massively transfused patients in terms of blood product usage, in-hospital mortality and length of stay for a range of clinical indications for platelet transfusion support.

Keywords: INTERCEPT Blood System; amotosalen; massive transfusion; pathogen reduction; platelets.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Austria
  • Blood Platelets / drug effects*
  • Blood Platelets / metabolism
  • Blood Platelets / radiation effects
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / surgery
  • Child
  • Child, Preschool
  • Female
  • Furocoumarins / pharmacology*
  • Hospital Mortality
  • Hospitals
  • Humans
  • Infant
  • Kaplan-Meier Estimate
  • Length of Stay
  • Liver Diseases / mortality
  • Liver Diseases / therapy
  • Liver Transplantation
  • Male
  • Middle Aged
  • Platelet Transfusion*
  • Retrospective Studies
  • Treatment Outcome
  • Ultraviolet Rays*
  • Wounds and Injuries / mortality
  • Wounds and Injuries / pathology
  • Young Adult

Substances

  • Furocoumarins
  • amotosalen