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We evaluated the evidence about whether people with a low platelet count require a platelet transfusion prior to insertion of a lumbar puncture needle or epidural catheter, and if so what is the platelet count level at which a platelet transfusion is required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

We evaluated the evidence about whether people with a low platelet count require a platelet transfusion prior to insertion of a central line (central venous catheter (CVC)), and if so what is the platelet count level at which a platelet transfusion is required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Hepatic cirrhosis is a severe disease with scars and nodules on the liver tissue. As a result, the normal function of the liver is impaired. Whatever the cause of cirrhosis, changes in the structure of and blood flow within the liver increase pressure in the portal vein (called portal vein hypertension), which is the vein that drains blood from the bowels to the liver. Portal hypertension induces dilatation (extension) of veins within the wall of the oesophagus (food pipe or gullet), which often rupture (break) with severe bleeding. Thus, when liver cirrhosis is diagnosed, an oesophago‐gastro‐duodenoscopy (OGD) is recommended to detect the presence of oesophageal varices (areas of abnormal dilatation of veins). During OGD, a small camera at the end of a tube is inserted down the oesophagus from the mouth and pictures are relayed back to a screen. Large varices or red signs on even small varices show high risks of rupture and bleeding. If high‐risk varices are found, treatment with beta‐blockers is effective in reducing the risk of bleeding. Three simple non‐invasive tests could be used to identify people with liver diease at high risk of having oesophageal varices: platelet count ‐ a simple laboratory test on a blood sample by which the number of platelets (a blood element ensuring coagulation) is measured; length (maximal diameter) of the spleen measured during ultrasound examination of the abdomen; and ratio of platelet count to spleen length.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 26, 2017

This review was undertaken to determine the best use of platelet transfusions for the prevention of bleeding in patients who have haematological disorders and are receiving intensive (myelosuppressive) chemotherapy or stem cell transplantation. The review aimed to look at three main topics. One, what is the evidence to indicate if platelet transfusions should be given to prevent bleeding as compared to a strategy aimed at transfusion when bleeding occurs? Second, if platelet transfusions are given to prevent bleeding, when should they be given, for example, at what level of platelet count when measured in a blood sample? Three, if platelet transfusions are given what platelet dose should be used? We are unable to answer the first question, however new data from two large studies should be available when this review is updated in approximately two years time. With regard to the second question, there is no evidence to suggest a change from the current practice of using a platelet count of 10 x 109/L to trigger the use of platelet transfusions to prevent bleeding. However, more research is required to clarify this issue. The final question can be answered. Using a lower platelet dose did not lead to an increased risk of bleeding and fewer platelets were required. The reduction in the number of platelets used should, theoretically, reduce the risk of adverse events although no true differences were seen in the studies. However, adverse events are uncommon and therefore a statistically significant difference may not be seen.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

We evaluated the evidence about whether giving agents that can replace, or reduce platelet transfusion (artificial platelets, platelet‐poor plasma, fibrinogen concentrate, recombinant activated factor VII (rFVIIa), recombinant factor XIII (rFXIII), recombinant interleukin (rIL)6 or rIL11, desmopressin (DDAVP), thrombopoietin (TPO) mimetics or antifibrinolytic drugs), to people with a low platelet count prevents bleeding and whether these alternative agents are associated with side effects. Our target population was people with bone marrow disorders which prevent them from producing enough platelets. We excluded people undergoing intensive chemotherapy or stem cell transplantation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

The aim of this review was to assess whether specially treated pathogen‐reduced platelets, work as well as normal platelets when transfused. Specifically, do they stop or prevent bleeding as well as standard platelets; do they produce the same increase in platelet count; and does their use affect further transfusion requirements? This review also assessed whether pathogen‐reduced platelets are as safe as normal platelets, for example are they associated with any difference in the rate of death following transfusion, and are there any side effects associated with the use of these products.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 30, 2017

We evaluated the evidence about whether platelet transfusions given to prevent bleeding in people with lower platelet counts (for example 5 x 109/L or below) were as effective and safe as the current standard (10 x 109/L or below), or whether higher platelet count levels (20 x 109/L or below, 30 x 109/L or below, or 50 x 109/L or below) were safer than the current standard (10 x 109/L or below). Our target population was people with blood cancers (for example leukaemia, lymphoma, myeloma) who were receiving intensive (myelosuppressive) chemotherapy treatments or stem cell transplantation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

We evaluated the evidence about whether low‐dose platelet transfusions (platelet transfusions containing a lower number of platelets (1.1 x 1011/m2 ± 25%)) given to prevent bleeding in people with low platelet counts were as effective and safe as standard‐dose (2.2 x 1011/m2 ± 25%) or high‐dose platelet transfusions (platelet transfusions containing a larger number of platelets (4.4 x 1011/m2 ± 25%)) given regularly to prevent bleeding (prophylactically). Our target population was children and adults with blood cancers who were receiving intensive chemotherapy treatments or stem cell transplantation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Pre‐eclampsia is a serious complication of pregnancy characterized by high blood pressure with protein in the urine and sometimes progression to seizures (fits). HELLP syndrome is a more severe form of pre‐eclampsia which can cause problems with liver function, blood clotting, and low platelets. HELLP may be diagnosed during pregnancy or after giving birth and is associated with ill health for the mother including liver hematoma, rupture, or failure; pulmonary edema; renal failure and death. Infant health may also be poor, primarily due to premature birth and growth restriction.This review examined the effect of treating women with HELLP syndrome using corticosteroids (which can reduce inflammation). The results of this review did not indicate that there was a clear effect on the health of pregnant women when treated with corticosteroids, or their babies. Corticosteroids did appear to improve some components of the women's blood tests, but it is not clear that this had an effect on their overall health. The review identified 11 randomized controlled trials involving 550 women that compared corticosteroid (dexamethasone, betamethasone, or prednisolone) given during pregnancy, just after delivery or in the postnatal period, or both before and after birth, with placebo or no treatment. Two further trials showed that there was no clear difference between dexamethasone and betamethasone on the substantive clinical outcomes for women or their infants. Dexamethasone did improve maternal platelet count and some biochemical measures to a greater extent than betamethasone.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Gaucher disease, a rare disorder, is caused by inherited deficiency of the enzyme glucocerebrosidase. This defect leads to the build‐up of a fatty material called glucocerebroside in various cells in the body. Untreated individuals may suffer from anaemia, a decrease in platelet counts, massive enlargement of the liver and spleen, and damage to the bones. Two different types of treatment are available: the intravenous supplementation of the deficient protein glucocerebrosidase (enzyme replacement therapy), or the oral administration of a drug that slows down the production of the fatty material that it normally breaks down (substrate reduction therapy).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

We evaluated the evidence regarding whether giving platelet transfusions to patients with low platelets who are bleeding (therapeutically) is as effective and safe as giving platelet transfusions regularly to prevent bleeding (prophylactically). Our target population was people with blood cancers who were receiving intensive myelosuppressive (causing decreased blood cell production) chemotherapy treatments or stem cell transplantation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

The optimal management of pregnant women with a previous child affected by fetomaternal alloimmune thrombocytopenia remains unclear.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

We evaluated the evidence about whether giving antifibrinolytics (tranexamic acid or epsilon‐aminocaproic acid) to people with a low platelet count prevents bleeding and whether these antifibrinolytics are associated with side effects. Our target population was people with haematological disorders who have a low platelet count and would usually be treated with platelet transfusions. We did not include people with immune thrombocytopenia because they are not usually treated with platelet transfusions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Idiopathic thrombocytopenic purpura (ITP) is an immune‐mediated hematologic disorder caused by a low blood platelet count (thrombocytopenia). Antiplatelet antibodies act against the platelets resulting in platelet destruction by the spleen. In adults, the clinical features of ITP often have an insidious onset and are highly variable, ranging from no symptoms, mild bruising, to mucosal bleeding, and skin discolorations. Management of ITP during pregnancy is complex because of large differences between maternal and fetal platelet counts. The circulating antibodies can cross the placenta and cause a neonatal passive immune thrombocytopenia that may increase the risk of cerebral haemorrhage in the newborn infant. For this reason, it seems reasonable that cesarean section delivery is safer for the infant than vaginal delivery yet the mode of delivery may not affect the rate of haemorrhage. Many different pharmacological interventions are used for treating this medical disorder and treatment for ITP in pregnant women is not standardised. Some of these drugs have potential side effects for pregnant women and some can cause fetal malformation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Chronic idiopathic thrombocytopenic purpura (ITP) is an acquired autoimmune disorder characterized by low platelet counts. To date, the therapies that primarily aim to reduce platelet destruction, such as corticosteroids, intravenous immunoglobulins and splenectomy, have been the mainstay of treatment in ITP. However, TPO receptor agonists such as romiplostim and eltrombopag, which aim to enhance platelet production, are novel drugs that have been suggested to be more effective. This review included six trials with 808 patients and compared TPO receptor agonists with placebo or standard of care (SOC).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Heparin is a natural agent used to prevent clot formation in the vessels. Two types of heparins are widely used, unfractionated heparin (UFH) and low molecular weight heparin (LMWH). Heparin‐induced thrombocytopenia (HIT) is an adverse reaction that can occur during treatment with heparin. It is common in practice and its most important consequence is a paradoxical increase in the risk of clotting (thromboembolic) complications. A number of factors are thought to influence its frequency, including the type of heparin and the type of patient, with patients who have had a surgery at higher risk. We compared the risk of HIT in people who had had surgery and had been exposed to UFH or LMWH. A better understanding of this problem will allow safer management of postoperative patients who need thromboprophylaxis with heparin.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 21, 2017

Central venous catheters (CVCs) are temporary devices implanted into patients when easy or frequent intravenous access is needed. Doctors often use them. A Hickman line is an example of a CVC. A CVC is used, for instance, for monitoring patients in intensive care, or for giving chemotherapy or intravenous nutrition. However, such catheters can cause blood clots, which can block the line, increase the risk of infection and travel elsewhere in the body such as to the lung (this is called thromboembolism). Heparin is a drug that helps to prevent blood clots and may help prevent these unwanted consequences. But heparin can also cause serious adverse effects (bleeding, allergic reactions, fall in platelet count, etc.). Normal saline solution, a sterile solution of salt in water at a concentration suitable for the blood, is typically used for intravenous infusions. We wanted to know whether heparin helps prevent the unwanted effects of blood clots in CVCs, and if this benefit outweighs its risk of harms.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Microvascular surgery refers to any surgery involving small sized blood vessels that is performed under the operating microscope, allowing the repair of arteries and veins of the digits. These are typically 1 mm to 2 mm in diameter. Replantation is the reattachment of a completely detached body part, with fingers and thumbs being the most commonly replanted body parts. This is often referred to as digital replantation. In principle, digital replantation involves not only restoring the blood flow through the arteries and veins but also restoring the bony skeleton of the toes, fingers or thumbs, along with repairing the tendons and nerves as indicated. Occlusion of one or more of the repaired vessels due to the formation of a clot (thrombus) within the blood vessel results in failure of the replantation. Anticoagulant medications are used to reduce clotting, and they could potentially prevent such a complication. Anticoagulants such as unfractionated heparin (UFH) have therefore been used to prevent clot formation after digital replantation. It is unclear if low molecular weight heparin (LMWH) has similar benefit. This systematic review identified only two randomised controlled trials comparing UFH with LMWH, with a total of 114 patients. No studies were identified that compared LMWH with placebo, no treatment or other anticoagulants. The limited data from the two trials showed no difference between LMWH and UFH in the success rate for digital replantation but there were less frequent anticoagulation‐related adverse events (such as bleeding) with LMWH. The available evidence is insufficient to make a firm conclusion.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Toxoplasma retinochoroiditis occurs when a parasite called Toxoplasma gondii gets into the retina (the light‐sensitive layer inside the eye) and the choroid (layer of the eyeball near the retina). This causes inflammation that can scar the retina and reduce vision. Symptoms include a sudden feeling of discomfort in the eye and loss of vision, which usually resolve spontaneously within six to eight weeks. The infection can keep returning, increasing the chances of damage. Antibiotics are sometimes used to try to reduce the inflammation and scarring, or to prevent the infection from re‐emerging, but it is unclear how well they work.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

This summary of a Cochrane review describes what we know from research about any safety issues from using non‐steroidal anti‐inflammatory drugs, or NSAIDs, including aspirin, or paracetamol (acetaminophen), or both, along with methotrexate in people with inflammatory arthritis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

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