PROPPR

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.

Holcomb JB, Tilley BC, Baraniuk S, et al. JAMA 2015 · PMID 25647203 · doi:10.1001/jama.2015.12

Question

In severely injured patients needing massive transfusion, does a 1:1:1 plasma:platelet:red cell ratio reduce mortality compared with 1:1:2?

Design

Pragmatic multicentre RCT in 12 North American level I trauma centres.

Patients

Severely injured adults predicted to need massive transfusion, arriving directly from the scene.

Intervention

Plasma, platelets and red cells in a 1:1:1 ratio

Comparison

1:1:2 ratio

Primary outcome

All-cause mortality at 24 hours and 30 days

Key result

There was no significant difference in 24-hour or 30-day mortality, but the 1:1:1 group achieved haemostasis more often and had fewer deaths from exsanguination in the first 24 hours, without more complications.

Limitations

The trial was powered for a larger mortality difference than was seen, and was conducted in US centres with rapid access to thawed plasma and platelets.

Impact on practice

Supports high-ratio, balanced haemostatic resuscitation in UK major haemorrhage protocols, with plasma and platelets given early alongside red cells.