Use of platelet transfusions and tranexamic acid in patients with myelodysplastic syndromes: A clinical practice survey

Abstract

AbstractAimThrombocytopenia and bleeding are common in myelodysplastic syndromes (MDS), but optimal management is unknown. We conducted a survey to identify current clinical practice regarding platelet transfusion (PLT‐T) and tranexamic acid (TXA) to inform future trial design.MethodA 25‐question survey was distributed to members of the ALLG from December 2020 to July 2021.ResultsSixty‐four clinicians across Australia, New Zealand and Singapore responded. Clinicians treated a median of 15 MDS patients annually. Twenty‐nine (45%) reported having institutional guidelines regarding prophylactic PLT‐T. Although 60 (94%) said they would consider using TXA, most (58/64; 91%) did not have institutional guidelines. Clinical scenarios showed prophylactic PLT‐T was more likely administered for patients on disease‐modifying therapy (49/64; 76%, commonest threshold <10 × 109/L) or with minor bleeding (32/64 [50%] transfusing at threshold <20 × 109/L, 23/64 [35%] at <10 × 109/L). For stable untreated patients, 29/64 (45%) would not give PLT‐T and 32/64 (50%) would. Most respondents (46/64; 72%) were interested in participating in trials in this area. Potential barriers included resource limitations, funding and patient/clinician acceptance.ConclusionReal‐world management of MDS‐related thrombocytopenia varies and there is a need for clinical trials to inform practice.