{"doi":"10.17615/h058-2d10","title":"Analysis of bleeding outcomes in patients with hypoproliferative thrombocytopenia in the A‐TREAT clinical trial","abstract":"Background: Despite prophylactic platelet transfusions, hypoproliferative thrombocytopenia is associated with bleeding; historical risk factors include hematocrit (HCT) ≤25%, activated partial thromboplastin time ≥30 s, international normalized ratio ≥1.2, and platelets ≤5000/μL. Methods: We performed a post hoc analysis of bleeding outcomes and risk factors in participants with hematologic malignancy and hypoproliferative thrombocytopenia enrolled in the American Trial to Evaluate Tranexamic Acid Therapy in Thrombocytopenia (A-TREAT) and randomized to receive either tranexamic acid (TXA) or placebo. Results: World Health Organization (WHO) grade 2+ bleeding occurred in 46% of 330 participants, with no difference between the TXA (44%) and placebo (47%) groups (p = 0.66). Overall, the most common sites of bleeding were oronasal (18%), skin (17%), gastrointestinal (11%), and genitourinary (11%). Among participants of childbearing potential, 28% experienced vaginal bleeding. Platelets ≤5000/μL and HCT < 21% (after adjusting for severe thrombocytopenia) were independently associated with increased bleeding risk (HR 3.78, 95% CI 2.16–6.61; HR 2.67, 95% CI 1.35–5.27, respectively). Allogeneic stem cell transplant was associated with nonsignificant increased risk of bleeding versus chemotherapy alone (HR 1.34, 95% CI 0.94–1.91). Discussion: The overall rate of WHO grade 2+ bleeding was similar to previous reports, albeit with lower rates of gastrointestinal bleeding. Vaginal bleeding was common in participants of childbearing potential. Platelets ≤5000/μL remained a risk factor for bleeding. Regardless of platelet count, bleeding risk increased with HCT < 21%, suggesting a red blood cell transfusion threshold above 21% should be considered to mitigate bleeding. More investigation is needed on strategies to reduce bleeding in this population.","journal":"UNC Libraries","year":2024,"id":504962,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9451,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":448036,"name":"Darrell J. Triulzi","orcid":null,"position":1,"is_corresponding":false},{"id":927816,"name":"Siobhan P. Brown","orcid":"0000-0002-4774-3122","position":2,"is_corresponding":false},{"id":694695,"name":"Nahed El Kassar","orcid":null,"position":3,"is_corresponding":false},{"id":770557,"name":"Susanne May","orcid":"0000-0002-3601-7432","position":4,"is_corresponding":false},{"id":489378,"name":"Heather Herren","orcid":null,"position":5,"is_corresponding":false},{"id":249627,"name":"Nigel S. Key","orcid":"0000-0002-8930-4304","position":6,"is_corresponding":false},{"id":737448,"name":"Amy Sarah Ginsburg","orcid":"0000-0002-2291-2276","position":7,"is_corresponding":false},{"id":287684,"name":"Anton Ilich","orcid":"0000-0002-7669-0760","position":8,"is_corresponding":false},{"id":926771,"name":"Jacqueline N. Poston","orcid":"0000-0003-2431-5106","position":9,"is_corresponding":false},{"id":557978,"name":"Terry Gernsheimer","orcid":"0000-0003-3631-8654","position":0,"is_corresponding":true}],"reference_count":0,"raw_metadata":null,"created_at":"2026-07-19T02:10:43.302033Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}