Platelets stored cold for up to 21 days controlled surgical bleeding as well as standard platelets

Design

Phase 3, randomised 2:1, partially blinded, adaptive Bayesian non-inferiority trial

Population

989 children and adults bleeding after cardiac surgery on bypass, 27 sites

Primary outcome

Haemostatic efficacy score (1–5)

Effect

Mean difference 0.09 (95% credible interval −0.06 to 0.23); non-inferior at all durations

The CHIPS trial randomised 1,000 children and adults having cardiac surgery on bypass who needed platelets for bleeding, two to one, to platelets stored at 1 to 6 °C for up to 21 days or to standard room-temperature platelets stored for up to seven days, at 27 US and Australian sites.

Cold-stored platelets were non-inferior on a 1-to-5 haemostatic efficacy score at every storage duration tested, with a mean difference of 0.09. Chest drain output at 24 hours was similar. Thrombotic events, transfusion reactions, ARDS, kidney failure and mortality did not differ, but surgical re-exploration was more frequent with cold-stored platelets.

Room-temperature platelets expire in five to seven days, which drives wastage and leaves many smaller hospitals and trauma services without any stock. Cold storage for three weeks could change that, particularly in district and rural hospitals in India where platelet availability limits massive transfusion. The trial was in cardiac surgery; use in trauma or medical bleeding is an extrapolation, and the re-exploration signal needs watching.

• Expect cold-stored platelets to appear in transfusion protocols as blood services adopt them.
• Use them for active bleeding, the setting tested here, rather than for prophylactic transfusion.
• Watch for re-exploration and bleeding complications, which were more frequent in this trial.
• Discuss with your blood bank whether longer platelet shelf life could support a local massive transfusion stock.

Why it matters

Platelet shelf life, not efficacy, is what keeps many hospitals without platelets in a bleeding emergency.

Don't overread it

The trial was in cardiac surgery; it does not establish equivalence in trauma or for prophylaxis.

The statistics, in plain English

The trial used a Bayesian design; a posterior probability above 99.9% means the data make it very likely that cold platelets are no worse than standard ones within the one-point margin. A credible interval is the Bayesian equivalent of a confidence interval.

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