About 18% of all hospitalized patients require central venous catheters (CVC) and is even more common on hematology wards and intensive care units (ICU) where patients often have thrombocytopenia. The AABB clinical practice guideline provides a weak recommendation that a minimum platelet count of 20,000 per cubic millimeter is needed before CVC placement. The panel also noted, however, more data are needed. Researchers in the Netherlands performed a multi-center, randomized, controlled noninferiority trial on prophylactic platelet transfusion prior to CVC placement in patients with thrombocytopenia (PACER). During the study, 338 patients with severe thrombocytopenia (platelet count 10,000 to 50,000 per cubic millimeter) on the hematology ward or ICU were randomized to receive either one unit of platelets before CVC placement or no transfusion. CVC-related grade 2 to 4 bleeding within 24 hours after placement was 4.8% (9/188) in the transfusion arm compared to 11.9% (22/185) in the no transfusion arm (relative risk, 2.45; 90% C.I., 1.27 to 4.70). Notably, bleeding was greater among patients who received nontunneled CVC as well as those with insertion sites in the subclavian vein who did not receive a prophylactic platelet transfusion compared to patients who received one unit of platelets. No significant differences were seen between trial arms for participants who received tunneled CVC or insertion site of the internal jugular vein. Results suggest a higher platelet count than 20,000 per cubic millimeter may be needed before CVC placement, but further studies are needed to optimize platelet thresholds, the amount of platelets transfused, and investigate subgroup differences based on CVC type and placement.
References:
- van Baarle FLF, van de Weerdt EK, van der Velden WJFM, Ruiterkamp RA, et al. Platelet transfusions before CVC placement in patients with thrombocytopenia. N Engl J Med 2023; 388:1956-1965.
- Kaufman RM, Djulbegovic B, Gernsheimer T, Kleinman S, et al. AABB. Platelet transfusion: a clinical practice guideline from the AABB. Ann Intern Med. 2015 Feb 3;162(3):205-13.
