Platelet Transfusion in Critical Care and Surgery: Evidence Based Review of Contemporary Practice and Future Directions.

UNASSIGNED Thrombocytopenia is prevalent in critical care, surgical, and trauma settings. Despite the fact that a significant proportion of these patients receive platelet transfusionduring their hospital course, much work remains to be done with regard to development of platelet transfusionguidelines. Given the wide variety of platelet transfusionpractices and the frequency with which patients present with thrombocytopenia, it is paramount to understand standards of care and to identify deficiencies that may exist. This review explores evidence and recommendations for platelet transfusionthresholds and practices in a varietyof criticalcare and surgical settings with specific focus on the role of platelet transfusionin trauma, management and reversal of anticoagulation, and pointof carelaboratory assays. To this end, a literature review was performed utilizing PubMed and Cochrane Central Register of Controlled Trials to select 153 manuscripts that evaluate the current data supporting platelet transfusionsin surgical and critical care populations. Advances in transfusion medicineand synthetic platelet substitutes that can be engineered for potential future applications will also be discussed.