Category: Hematology/Oncology
Keywords: CVC, Central Line Placement, Thrombocytopenia, Platelets, Transfusion (PubMed Search)
Posted: 1/22/2024 by Sarah Dubbs, MD
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The routine use of ultrasound guidance has decreased CVC-related complications, especially in patients at risk for bleeding. To this day, however, platelet transfusion threshold guidelines range widely from 20,000 - 50,000 platelets per cubic millimeter, and also lack good-quality evidence.
This multicenter, randomized, controlled, noninferiority trial randomly assigned patients with severe thrombocytopenia (platelet count 10,000 to 50,000 per cubic millimeter) to receive either one unit of prophylactic platelet transfusion or no platelet transfusion before ultrasound-guided CVC placement.
Author's Conclusions: Withholding prophylactic platelet transfusion before CVC placement in patients with a platelet count of 10,000 to 50,000 per cubic millimeter did NOT meet the predefined margin for noninferiority and resulted in more CVC-related bleeding events than prophylactic platelet transfusion.
BUT…taking a closer look at this study reveals many nuanced points. Many of the study patients were heme/onc patients possibly having bleeding issues outside of low platelets, bleeding complications trended with subclavian and femoral locations as well as lower initial platelet counts. All this suggests that additional studies need to be done to move towards more specific evidenced-based guidelines.
To read more details on the study, click the referenced link.
