PROPPR
Trial question
What is the effect of early administration of plasma, platelets, and RBCs in a 1:1:1 ratio in patients with severe trauma and major bleeding?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
20.0% female
80.0% male
N = 680
680 patients (134 female, 546 male).
Inclusion criteria: patients with severe trauma and major bleeding who were predicted to receive a massive transfusion.
Key exclusion criteria: age < 15 years; weight < 50 kg; lethal traumatic brain injury; receipt of lifesaving intervention from an outside hospital.
Interventions
N=338 1:1:1 (receipt of blood transfusion of plasma, platelets, and RBCs in the ratio of 1:1:1).
N=342 1:1:2 (receipt of blood transfusion of plasma, platelets, and RBCs in the ratio of 1:1:2).
Primary outcome
All-cause mortality at 24 hours
12.7%
17%
17.0 %
12.8 %
8.5 %
4.3 %
0.0 %
1:1:1
1:1:2
No significant
difference ↔
No significant difference in all-cause mortality at 24 hours (12.7% vs. 17%; ARD -4.2, 95% CI -9.6 to 1.1).
Secondary outcomes
No significant difference in all-cause mortality at 30 days (22.4% vs. 26.1%; ARD -3.7, 95% CI -10.2 to 2.7).
Significant decrease in death due to exsanguination within 24 hours (9.2% vs. 14.6%; ARD -5.4, 95% CI -10.4 to -0.5).
Significant increase in hemostasis (86.1% vs. 78.1%; AD 8%, 95% CI 2.3 to 13.7).
Safety outcomes
No significant differences in ARDS, multiple organ failure, VTE, sepsis and transfusion-related complications.
Significant difference in receipt of plasma (7 U vs. 5 U) and platelets (12 U vs. 6 U).
Conclusion
In patients with severe trauma and major bleeding who were predicted to receive a massive transfusion, 1:1:1 was not superior to 1:1:2 with respect to all-cause mortality at 24 hours.
Reference
John B Holcomb, Barbara C Tilley, Sarah Baraniuk et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015 Feb 3;313(5):471-82.
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