Written by Millie Cosse
Spoon Feed
Clinically relevant bleeding events were more common after central venous catheter placement in patients with platelet counts of 10,000 to 50,000/mm3 who did not receive prophylactic platelet transfusion than those who did.
A “fine line” between safety and utilization management
There is limited data and varying institutional protocols guiding the practice of prophylactic platelet transfusion prior to central line placement. These authors conducted a multicenter, randomized, controlled, noninferiority trial of 338 patients with platelet counts of 10,000-50,000/mm3 in intensive care and hematology units in the Netherlands who were randomized to either prophylactic platelet transfusion or no transfusion prior to central line placement. The central lines were placed by experienced operators and could be any diameter, tunneled or nontunneled, and placed in the internal jugular, subclavian, or femoral veins.
The authors found that catheter-related significant bleeding occurred in 9 of 188 patients (4.8%) in the transfusion group and in 22 of 185 patients (11.9%) in the no-transfusion group: relative risk 2.45 (90%CI 1.27-4.70). The absolute risk difference between the two groups was 7.1%, meaning that no-transfusion was not noninferior (Translation: significantly more bleeding in the no transfusion group).
It is important to note that these lines were not necessarily placed under emergent conditions. Additionally, the authors defined experienced operator in this case as someone who has performed at least 50 CVC placements, which is not the case in many academic emergency departments where residents primarily act as proceduralists.
How will this change my practice?
I will continue to transfuse emergency department patients to a platelet goal >50,000/mm3 before placing a central line whenever it is possible to do so.
Source
Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia. N Engl J Med. 2023 May 25;388(21):1956-1965. doi: 10.1056/NEJMoa2214322.
