Prophylactic Platelets in Dengue: Survey Responses Highlight Lack of an Evidence Base

Dengue is the most important arboviral infection of humans. Thrombocytopenia is frequently observed in the course of infection and haemorrhage may occur in severe disease. The degree of thrombocytopenia correlates with the severity of infection, and may contribute to the risk of haemorrhage. As a result of this prophylactic platelet transfusions are sometimes advocated for the prevention of haemorrhage. There is currently no evidence to support this practice, and platelet transfusions are costly and sometimes harmful. We conducted a global survey to assess the different approaches to the use of platelets in dengue. Respondents were all physicians involved with the treatment of patients with dengue. Respondents were asked that their answers reflected what they would do if they were the treating physician. We received responses from 306 physicians from 20 different countries. The heterogeneity of the responses highlights the variation in clinical practice and lack of an evidence base in this area and underscores the importance of prospective clinical trials to address this key question in the clinical management of patients with dengue. Author Summary: A low platelet count is a common feature of dengue infection. It is thought that the platelet count correlates with the severity of the infection and may contribute to the risk of developing haemorrhage, a well-recognised complication of dengue. As a result of this platelet transfusions are used in some settings to reduce the risk of haemorrhage. There is currently no evidence to support this practice, and platelet transfusions are costly and sometimes harmful. We conducted a survey assessing the use of platelets in dengue. Respondents were all physicians involved with the treatment of patients with dengue. Respondents were asked that their answers reflected what they would do if they were the treating physician. We received 306 responses from 20 different countries. The striking feature of the survey responses was the heterogeneity of approaches to the use of platelets in dengue. These findings highlight the variation in clinical practice and lack of an evidence base in this area and underscore the importance of conducting prospective clinical trials to address this key question in dengue clinical management.