Sanne de Bruin

67 Transfusion practice in the bleeding critically ill; an international online survey – The TRACE-2 Survey Of the respondents, 67% reported that they always checked the platelet count before transfusing a second unit of platelets. Furthermore, 13% reported doing this most of the time, and 13%only sometimes. Respondents who only sometimes or never checked the platelet count transfused at higher platelet counts in patients after cardiothoracic surgery (p=0.044, Additional file 4 Figure S1). Coagulation supportive therapy Fibrinogen administration was triggered at a level of 1.5[1-1.8] g/L in the general ICU population for non-massive bleeding. The differences in fibrinogen thresholds used in other subpopulations were small, but statistically significant. Trauma patients, obstetric patients, patients on ECMO, upper GI bleeding cases, post-cardiothoracic surgery pa- tients and patients with traumatic brain injury would receive fibrinogen at a threshold of 1.5[1-2] g/L and in patients with sepsis, fibrinogen would be administered at a fibrinogen level of 1.5[1-1.9] g/L (Figure 3C). The use of TXA differed between subpopulations. It was most often considered in trauma followed by obstetric patients (Figure 2B). TXA was mostly administered em- pirically in non-massively bleeding patients (68%), whereas some respondents (24.4%) performed viscoelastic testing before administering TXA. Most respondents reported that they use the INR or PT to decide whether a non-mas- sively bleeding patient could benefit from a plasma transfusion (88%), followed by activated partial thromboplastin time (aPTT, 59%), fibrinogen level (48%) and visco- elastic testing (42%). An INR of 2 (IQR=1.6 – 2.5) was used as the threshold for plasma transfusion. Of the respondents, 24% and 31.9% respectively reported that they always or most of the time checked the INR, PT or the viscoelastic test again before transfusing a second unit of plasma. 23% and 20% checked these tests sometimes or never. Effect of respondents’ primary specialty on transfusion practices during non-massive bleeding The primary specialties of anesthesiology and internal medicine were sufficiently pow- ered to test the effect of specialty on transfusion practice. For RBC transfusion, only for patients with traumatic brain injury or a hemorrhagic stroke was a small difference seen. Anesthesiologists would transfuse at a higher Hb level of 8[7.4-9] g/dL versus internists 8[7-9] g/dL (p=0.044). (See Additional file 3 table S2). For platelet transfusion, significant differences were observed inmore patient categories (Additional file 3 table S2). In cardiothoracic surgery, obstetric complications, septic patients and those who recently used anti-platelet drugs, anesthesiologists would transfuse at higher platelet 3