6/29/23, 1:44 AM PROPPR Pathway Feedback Search Clinical Topics Home Studies PROPPR PROPPR Disease Disease Platelet transfusion Traumatic hemorrhage Trial question What is the effect of early administration of plasma, platelets, and RBCs in a 1:1:1 ratio in patients with severe trauma and major bleeding? Study design Multi-center Open label RCT Population Characteristics of study participants 20.0% female N = 680 80.0% male 680 patients (134 female, 546 male) Inclusion criteria: patients with severe trauma and major bleeding who were predicted to receive a massive transfusion Key exclusion criteria: age < 15 years; weight < 50 kg; lethal TBI; receipt of lifesaving intervention from an outside hospital Interventions N=338 1:1:1 (receipt of blood transfusion of plasma, platelets, and RBCs in the ratio of 1:1:1) N=342 1:1:2 (receipt of blood transfusion of plasma, platelets, and RBCs in the ratio of 1:1:2) Primary outcome https://web.pathway.md/studies/recY9tNdHLej5wDKU 1/2 6/29/23, 1:44 AM PROPPR Pathway Death from all causes at 24 hours 17.0 % 17 12.8 % 12.7 8.5 % 4.3 % No significant difference 0.0 % 1:1:1 1:1:2 No significant difference in death from all causes at 24 hours (12.7% vs. 17%; ARD -4.2, 95% CI -9.6 to 1.1) Secondary outcomes No significant difference in death from all causes at 30 days (22.4% vs. 26.1%; ARD -3.7, 95% CI -10.2 to 2.7) Significant decrease in death due to exsanguination within 24 hours (9.2% vs. 14.6%; ARD -5.4, 95% CI -10.4 to -0.5) Significant increase in hemostasis (86.1% vs. 78.1%; AD 8%, 95% CI 2.3 to 13.7) Safety outcomes No significant differences in ARDS, multiple organ failure, VTE, sepsis and transfusion-related complications. Significant difference in receipt of plasma (7 U vs. 5 U) and platelets (12 U vs. 6 U). Conclusion In patients with severe trauma and major bleeding who were predicted to receive a massive transfusion, 1:1:1 was not superior to 1:1:2 with respect to death from all causes at 24 hours. Reference John B Holcomb, Barbara C Tilley, Sarah Baraniuk et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015 Feb 3;313(5):471-82. Open reference URL https://web.pathway.md/studies/recY9tNdHLej5wDKU 2/2