The following is a summary of the article “Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia,” published in the May 2023 issue of Hematology by Baarle et al.
Due to evidence gaps, there are conflicting guidelines on platelet counts for central venous catheter (CVC) placement. Ultrasound guidance reduces CVC-related bleeding.
Researchers performed a retrospective study on patients with severe thrombocytopenia (platelet count: 10,000 to 50,000/mm3) in a randomized trial who received one prophylactic platelet unit or none before ultrasound-guided CVC insertion. Specifically, catheter-related bleeding (grades 2-4), severe bleeding (grades 3–4), and non-inferiority threshold is 3.5 for determining the relative risk.
The results analyzed 373 episodes of CVC placement with 338 patients. Catheter-related bleeding (grade 2-4) in 9 of 188 patients (4.8%) in the transfusion group and 22 of 185 patients (11.9%) in the no-transfusion group (relative risk, RR: 2.45; 90% CI: 1.27 to 4.70). Catheter-related bleeding (grade 3 or 4) in 4 of 188 patients (2.1%) in the transfusion group, 9 of 185 patients (4.9%) in the no-transfusion group (relative risk [RR]: 2.43; 95% CI: 0.75 to 7.93). Of the total 15 adverse events, 13 (all grade 3 catheter-related bleeding [4 in the transfusion group, 9 in the no-transfusion group]) were categorized as severe and saved $410 per catheter placement by not using prophylactic platelet transfusions.
They concluded there was no meeting of the predefined noninferiority margin. More CVC-related bleeding events occur in patients with a platelet count of 10,000–50,000 per cubic millimeter without a prophylactic platelet transfusion.
Source: nejm.org/doi/full/10.1056/NEJMoa2214322
