The authors retrospectively evaluated the impact of various apheresis platelet (aPLT) ratios as a part of a massive transfusion protocol in combat casualties. An aPLT:RBC ratio ≥ 1:8 a was associated with improved survival at 24 hours and at 30 days in combat casualties requiring massive transfusion within 24 hours of injury.

However, there are a few concerns:
1. Although the groups are very similar with regard to demographics, injury and severity, they seem to be treated differently. For example, the high platelet group received more plasma, more cryoprecipitate and more rFVIIa compared to the low platelet groups.
2. No laboratory data (platelets and coagulation parameters) are presented.
3. The timing of platelet administration is not reported. Can the early mortality after 2 hours be explained by a more aggressive management in the high platelet group?

This paper highlights the importance of (early?) platelet transfusions in massively injured patients. As with other coagulation factors, the optimal timing and ratio of platelet transfusions has to be clarified in randomized trials.

– Hans Gombotz

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