Clinical Scorecard: Cold-stored platelets met noninferiority criteria for hemostatic efficacy through 21 days

At a Glance

Key Highlights

• In the phase 3 CHIPS trial, cold-stored platelets met the prespecified noninferiority criterion for hemostatic efficacy at every evaluated storage duration through 21 days.
• The primary outcome assessed bleeding during the 24 hours after the first platelet transfusion; pooled mean scores were 3.08 with cold-stored and 2.99 with room-temperature platelets.
• There was no statistically significant between-group difference in 24-hour chest tube output.
• Reexploration for bleeding within 24 hours occurred in 4.2% of cold-stored platelet recipients and 1.8% of room-temperature platelet recipients; cold-stored recipients also received greater volumes of several blood products.
• Exploratory safety analyses found no statistically significant differences in thrombotic events, transfusion-associated adverse events, acute respiratory distress syndrome, kidney failure, septic shock, or mortality.

Guideline-Based Recommendations

Diagnosis

• The trial assessed bleeding during the 24 hours after the first platelet transfusion using a 5-level hemostatic efficacy score; higher scores indicated greater bleeding.

Management

• The study compared cold-stored platelets maintained at 1°C to 6°C for up to 21 days with conventional platelets stored at 20°C to 24°C for up to 7 days.
• The authors described cold storage as a potential approach to extending platelet availability for active bleeding, particularly where conventional platelet inventories cannot be maintained, and emphasized interpreting findings within existing transfusion practices.

Monitoring & Follow-up

• The secondary outcome was chest tube output at 24 hours; median output was 8.9 mL/kg with cold-stored platelets and 8.4 mL/kg with room-temperature platelets, with no statistically significant between-group difference.
• Exploratory outcomes included reexploration for bleeding and blood product use at 24 and 72 hours after intensive care unit admission.

Risks

• Reexploration for bleeding within 24 hours occurred in 4.2% of cold-stored platelet recipients and 1.8% of room-temperature platelet recipients; the cold-stored group also received greater blood product volumes.
• Transfusion indications and thresholds for blood components and other interventions were not standardized, and some patients received both platelet types; the authors noted these limitations could affect interpretation.

Patient & Prescribing Data

Of 1,811 randomized pediatric and adult patients, 1,000 received platelet transfusions; the primary efficacy analysis included 989 patients. Participants underwent complex cardiac surgery with planned cardiopulmonary bypass and anticipated bleeding requiring platelet transfusion.

Patients were randomized 2:1 to cold-stored platelets (up to 21 days) or room-temperature platelets (up to 7 days). Cold-stored platelets met the primary noninferiority criterion, but the cold-stored group had higher observed reexploration rates and greater blood product use.

Clinical Best Practices

• Interpret the trial findings in the context of existing platelet transfusion practices in complex cardiac surgery, as emphasized by the authors.
• Consider the reported differences in reexploration for bleeding and blood product requirements alongside the noninferiority result.
• Note that platelet transfusion indications and transfusion thresholds were not standardized in the trial.

Related Resources & Content

• JAMA — CHIPS phase 3 trial