Platelet utilization before and after implementing a single apheresis unit transfusion policy in patients with upper gastrointestinal bleeding: a retrospective cohort study

Evidence regarding single-unit platelet transfusion policies in patients with active upper gastrointestinal bleeding remains limited. This study compared platelet utilization, transfusion-related parameters, and selected clinical outcomes before and after implementation of a hospital-wide single-unit platelet transfusion policy. A retrospective pre–post cohort study was conducted among patients with upper gastrointestinal bleeding who received platelet transfusion at a tertiary medical center. The pre-policy period was October 2017 to September 2018 (n = 105), and the post-policy period was October 2020 to September 2021 (n = 75). Platelet utilization, paired pre- and post-transfusion platelet parameters, in-hospital mortality, length of stay, endoscopic findings, and selected vital-sign and hemoglobin indicators were compared between periods using two-sided statistical tests. The post-policy period was associated with lower total platelet utilization (count ratio, 0.64; 95% CI 0.49–0.85; p = 0.002) and fewer platelet transfusion episodes (count ratio, 0.67; 95% CI 0.52–0.91; p = 0.008). Although the median platelet dose per transfusion episode was 1.00 unit in both periods, the mean decreased from 1.06 ± 0.18 to 1.00 ± 0.00 units ( p < 0.001), reflecting greater conformity to the one-unit default after policy implementation. Among patients with paired platelet measurements, no statistically significant differences were observed in post-transfusion platelet count, platelet count increment, or increment per apheresis unit. In-hospital mortality was 34.29% before and 38.67% after policy implementation ( p = 0.546), and median length of stay was 10 days in both periods ( p = 0.606). Rates of oxygen saturation below 95%, systolic blood pressure below 90 mmHg, and hemoglobin below 7 or 8 g/dL did not differ significantly. The post-policy cohort had higher frequencies of active bleeding and suspected rebleeding, indicating differences in clinical case mix between periods. The post-policy period was associated with lower platelet utilization and greater conformity to a one-unit transfusion default. Selected clinical, laboratory, and platelet-response outcomes did not differ significantly between periods; however, the retrospective pre–post design, differences in case mix, and potential temporal confounding preclude conclusions regarding safety, efficacy, or causality.