Platelet Transfusion Before CVC Placement May Reduce Risk of Bleeding in Patients With Thrombocytopenia

Forgoing prophylactic platelet transfusion may increase the risk of bleeding complications for patients with severe thrombocytopenia when a central venous catheter (CVC) is placed, according to research published in the New England Journal of Medicine.

CVC placement without platelet transfusion was inferior to placement with prophylactic transfusion in a randomized study that included 373 patients in hematology wards or the intensive care units (ICU) at 10 hospitals in the Netherlands.

The primary outcome of grade 2 to 4 catheter-related bleeding occurred in 9 of 188 patients (4.8%) who received transfusion, compared with 22 of 185 patients (11.9%) in the nontransfused group. Bleeding severity was determined using a bleeding scale adapted from the Common Terminology Criteria for Adverse Events.

The risk of major (grade 3 or 4) bleeding — a key secondary outcome — related to CVC placement was lower in the transfusion group than in the no-transfusion group (2.1% versus 4.9%).

The study included patients with thrombocytopenia with a platelet count of 10,000 to 50,000/mm³ within 24 hours before the procedure. Patients were randomly assigned in a 1:1 ratio to receive either one unit of platelet concentrate or no transfusion prior to CVC placement. Placement was performed by an experienced operator (more than 50 placements) using ultrasound guidance.

“Despite our overall findings regarding CVC-related bleeding complications in all patients with a platelet count of 10,000 to 50,000 per cubic millimeter, we would advocate for a more personalized approach,” the researchers wrote. “We would consider prophylactic platelet transfusion in patients with a platelet count of less than 30,000 per cubic millimeter, especially on the hematology ward, because these patients are likely to require a platelet transfusion within 24 hours anyway. For patients in the ICU with lower platelet counts, we would consider a no-transfusion strategy with intensive monitoring and a low threshold for the therapeutic use of blood products.”