Port implantation in patients with severe thrombocytopenia

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This retrospective study evaluates the safety of interventional radiological TIVAP implantation in patients with severe thrombocytopenia” Keulers et al (2017).

Abstract:

PURPOSE: Platelet counts <50/nl are often considered a contraindication for surgical and interventional radiology procedures. Yet, there are patients requiring totally implantable venous access ports (TIVAP) in whom normalization of the coagulation state is not feasible. This retrospective study evaluates the safety of interventional radiological TIVAP implantation in patients with severe thrombocytopenia.

MATERIALS AND METHODS: From 12/2010 to 12/2014, a total 1200 consecutive radiological TIVAP implantations were performed and retrospectively analyzed. Among those 181 patients had platelet counts (PC) below the reference value of 150-350 thrombocytes/nl: 55 patients with mild (PC: 100-150/nl), 58 patients with moderate (PC: 50-100/nl) and 68 patients with severe thrombocytopenia (PC <50/nl). All patients diagnosed with severe thrombocytopenia received platelet concentrates before or during the procedure according to a fixed preparation protocol. All patients were assessed at least 2 weeks before and up to 12 months after intervention. Outcome parameters were recorded with a particular focus on bleeding complications. Data were statistically analyzed with a p value <0.05 considered statistically significant. RESULTS: The technical success rate for TIVAP implantation was 100%. Patients were followed for a mean of 833 indwelling catheter days in patients with thrombocytopenia (total: 150.923 days) and for 936 indwelling catheter days in patients with normal platelet counts (total: 953.760 days). No significant differences in complication rates between patients with normal platelet counts and patients with mild to severe thrombocytopenia under platelet substitution were found (p > 0.05), especially no bleeding complications occurred during acute, early or late phase.

CONCLUSION: With individualized platelet substitution, patients with severe thrombocytopenia may receive radiological TIVAP implantation without an increased risk of bleeding complications.

LEVEL OF EVIDENCE: IV.

Reference:

Keulers, A.R., Kiesow, L. and Mahnken, A.H. (2017) Port Implantation in Patients with Severe Thrombocytopenia is Safe with Interventional Radiology. Cardiovascular and Interventional Radiology. September 13th. [Epub ahead of print].

doi: 10.1007/s00270-017-1794-y.

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