Cryopreserved platelets, designed to address shortages caused by the short shelf life of standard platelets, were more costly and less effective than liquid-stored platelets in Australian cardiac surgery patients, according to a new economic evaluation.
Platelet transfusion is essential for managing major bleeding during and after cardiac surgery, but liquid-stored platelets can only be kept for five to seven days. Cryopreserved platelets, which can be stored for up to two years, offer logistical advantages. However, their economic value in routine clinical practice has remained uncertain.
Higher Costs Without Clear Benefit
The study included 202 adults undergoing cardiac surgery at 11 Australian tertiary hospitals between August 2021 and April 2024. All participants were considered at high risk of requiring platelet transfusion. Of these, 104 received cryopreserved platelets and 98 received liquid-stored platelets.
Researchers found that the mean per-patient cost was A$15,035 (95% CI, −A$1878 to A$31 949) higher for cryopreserved platelets compared with liquid-stored platelets, although the difference was not statistically significant. Costs included intensive care unit admissions, hospital stays, and blood products, calculated in 2023 Australian dollars.
Increased Bleeding Compared With Standard Platelets
Clinical outcomes consistently favoured liquid-stored platelets. Patients who received cryopreserved platelets experienced significantly more postoperative bleeding, including an average of 121 mL more blood loss within 24 hours of intensive care admission and 504 mL more total blood loss overall. Rates of severe, type 4 bleeding was also 12.3% (95% CI, 1% to 23.6%) higher in the cryopreserved group.
Ninety-day mortality did not differ significantly between the two groups, and serious adverse events were rare, with only one reported in each arm of the trial.
Implications For Platelet Use In Australia
Taken together, the findings indicate that cryopreserved platelets were both more expensive and less effective, for managing bleeding in cardiac surgery at tertiary hospitals. While cryopreserved platelets may still have a role in regional or remote settings where platelet availability is limited, the authors conclude that liquid-stored platelets remain the preferred option for routine cardiac surgery in Australia.
Reference
Orman Z et al. Cost-effectiveness of cryopreserved vs liquid-stored platelets for managing surgical bleeding. JAMA Netw Open. 2025;8;(12):e2554363.
