Trial reportThe journal of trauma and acute care surgery2020
Dynamic impact of transfusion ratios on outcomes in severely injured patients: Targeted machine learning analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios randomized clinical trial.
Trial report in The journal of trauma and acute care surgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 3 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
12 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Artificial intelligence in the identification and prediction of adverse transfusion reactions(ATRs) and implications for clinical management: a systematic review of models and applications.BMC medical informatics and decision making · 2025Pooled it
- Blood transfusion strategies for major bleeding in trauma.The Cochrane database of systematic reviews · 2025Pooled it
- The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition.Critical care (London, England) · 2023Guideline
- Hemostatic Resuscitation in Trauma-Induced Coagulopathy: A Comprehensive Narrative Review.Medicina (Kaunas, Lithuania) · 2026Review
- Who Needs Most? Multicenter Subanalysis of Blood Transfusion Profiles in the German Patient Blood Management Network Registry.Journal of clinical medicine · 2026Article
- Artificial Intelligence in Patient Blood Management: A Systematic Review of Predictive, Diagnostic, and Decision Support Applications.Journal of clinical medicine · 2025Review
- Machine learning in transfusion medicine: A scoping review.Transfusion · 2024Article
- Survival and neurologic outcomes following aortic occlusion for trauma and hemorrhagic shock in a hybrid operating room.World journal of emergency surgery : WJES · 2023Article
- Survival and neurologic outcomes following aortic occlusion for trauma and hemorrhagic shock in a hybrid operating room.Research square · 2023Article
- Coagulopathy management of multiple injured patients - a comprehensive literature review of the European guideline 2019.EFORT open reviews · 2022Review
- Machine learning in perioperative medicine: a systematic review.Journal of anesthesia, analgesia and critical care · 2022Review
- Clinical Impact of a Dedicated Trauma Hybrid Operating Room.Journal of the American College of Surgeons · 2021Article
Corrections and comments
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Authors and funding
11 authors.
Funding
Abstract
backgroundMassive transfusion protocols to treat postinjury hemorrhage are based on predefined blood product transfusion ratios followed by goal-directed transfusion based on patient's clinical evolution. However, it remains unclear how these transfusion ratios impact patient outcomes over time from injury.
methodsThe Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) is a phase 3, randomized controlled trial, across 12 Level I trauma centers in North America. From 2012 to 2013, 680 severely injured patients required massive transfusion. We used semiparametric machine learning techniques and causal inference methods to augment the intent-to-treat analysis of PROPPR, estimating the dynamic relationship between transfusion ratios and outcomes: mortality and hemostasis at different timepoints during the first 24 hours after admission.
resultsIn the intention-to-treat analysis, the 1:1:1 group tended to have decreased mortality, but with no statistical significance. For patients in whom hemostasis took longer than 2 hours, the 1:1:1 ratio was associated with a higher probability of hemostasis, statistically significant from the 4 hour on. In the per-protocol, actual-transfusion-ratios-received analysis, during four successive time intervals, no significant association was found between the actual ratios and mortality. When comparing patient groups who received both high plasma/PRBC and high platelet/PRBC ratios to the group of low ratios in both, the relative risk of achieving hemostasis was 2.49 (95% confidence interval, 1.19-5.22) during the third hour after admission, suggesting a significant beneficial impact of higher transfusion ratios of plasma and platelets on hemostasis.
conclusionOur results suggest that the impact of transfusion ratios on hemostasis is dynamic. Overall, the transfusion ratios had no significant impact on mortality over time. However, receiving higher ratios of platelets and plasma relative to red blood cells hastens hemostasis in subjects who have yet to achieve hemostasis within 3 hours after hospital admission. LEVEL OF EVIDENCE: Therapeutic IV.
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