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Résumé : Background. Thrombocytopenia is common in dengue. Prophylactic platelet transfusion is widely practiced but platelet response kinetics in adult patients is not well described. Methods. A multicenter, open-label, randomized study of prophylactic platelet transfusion versus supportive care in adult dengue patients with platelet counts ≤20 × 103/µL was conducted in 5 hospitals in Singapore and Malaysia. Platelet outcomes studied were as follows: platelet increment at 1, 12 and 24 hours post-transfusion, daily platelet count until discharge or study day 7, and median time to platelet count >50 × 103/µL. Results. 182 patients were randomized to supportive care and 187 to prophylactic platelet transfusion with similar baseline age, gender, co-morbidities, clinical bleeding, warning signs and disease severity between the two groups. The median platelet increment (×103/µL) among transfused patients at 1 hour was 16 (interquartile range [IQR], 8 to 24), 12 hours was 13 (IQR, 5 to 22) and 24 hours was 25 (IQR, 13 to 41). Median platelet count change (×103/µL) was significantly lower in the non-transfused than transfused group on study day 2 (5 [IQR, −1 to 12] versus 13 [IQR, 3 to 22], p < 0.001), but was similar from study day 3 (27 [IQR, 12-47] versus 28 [IQR, 15 to 49], p = 0.500) to day 7 (111 [IQR, 47 to 299] versus 119 [IQR, 64.5 to 186], p = 0.860). By study day 7, 100 (55.0%) of supportive care and 109 (58.3%) of transfused group patients had platelet counts >50 × 103/µL (p = 0.530). Median time to platelet count >50 × 103/µL was 4 days in both groups (p = 0.389). More adverse events occurred in the prophylactically transfused than non-transfused group (13 [6.9%] versus 2 [1.1%], p = 0.006). Conclusion. Platelet response to prophylactic platelet transfusion was transient. Adverse events were more common among platelet-transfused patients. Disclosures. All authors: No reported disclosures.