Vascular Access Conversation - IVUPDATE Podcast from IVTEAM

"In this single center retrospective cohort study of ultrasound-guided central venous access in patients with very low platelet counts, no major bleeding was identified, and prophylactic platelet transfusions did not significantly decrease minor bleeding events" Zarama et al (2023).

Thrombocytopenia and risk of bleeding associated with CVC placement

Abstract:

Background: Reported risk of bleeding complications after central catheter access in patients with thrombocytopenia is highly variable. Current guidelines recommend routine prophylactic platelet transfusion before central venous catheter placement in patients with severe thrombocytopenia. Nevertheless, strength of such recommendations is weak and supported by observational studies including few patients with very low platelet counts (PLT < 20x109 /L). This study aims to assess the risk of bleeding complications related to using or not using prophylactic platelet transfusion before ultrasound-guided central venous access in patients with very low platelet counts.

Methods: This was a retrospective cohort study of patients with very low PLT counts (PLT< 20x109 /L) subjected to ultrasound-guided central venous catheterization between January 2011 and November 2019 in a university hospital. Bleeding complications were graded according to the Common Terminology Criteria for Adverse Events. A multivariate logistic regression was conducted to assess the risk of major and minor bleeding complications comparing patients who did or did not receive prophylactic platelet transfusion for the procedure. Multiple imputation by chained equations was used to handle missing data. A 2-tailed P < .05 was considered statistically significant.

Results: Among 221 patients with very low platelets, 72 received prophylactic platelet transfusions while 149 did not. Baseline characteristics were similar between transfused and non-transfused patients. No major bleeding events were identified, while minor bleeding events were recognized in 35.7% of patients. Multivariate logistic regression analysis showed no significant differences in bleeding complications between patients who received prophylactic platelet transfusions and those who did not (OR 0.83, 95% CI 0.45-1.55, p= 0.567). Additional complete case and sensitivity analyses yielded similar results to the main analysis.

Conclusions: In this single center retrospective cohort study of ultrasound-guided central venous access in patients with very low platelet counts, no major bleeding was identified, and prophylactic platelet transfusions did not significantly decrease minor bleeding events.


Reference:

Zarama V, Revelo-Noguera J, Quintero JA, Manzano R, Uribe-Buriticá FL, Carvajal DF, Ochoa LM, Valencia-Orozco A, Sánchez ÁI, Ospina-Tascón GA. Prophylactic platelet transfusion and risk of bleeding associated with ultrasound-guided central venous access in patients with severe thrombocytopenia. Acad Emerg Med. 2023 Jan 1. doi: 10.1111/acem.14651. Epub ahead of print. PMID: 36587310.