Withholding platelet transfusion from thrombocytopenic patients with central venous catheters = more bleeding events

Reference

Van Baarle FLF, Van de Weerdt EK, Van der Velden WJFM, et al. Platelet transfusion before CVC placement in patients with thrombocytopenia. N Engl J Med 2023;388(21):1956-1965.

Synopsis

For this noninferiority study from the Netherlands, the investigators enrolled patients from hematology wards and intensive care units who had a platelet count of 10,000 to 50,000 per cubic millimeter and required placement of a central venous catheter (CVC). Patients were randomized to receive either one unit of platelets (n = 197) or no transfusion (n = 196) prior to CVC placement. Patients who were receiving therapeutic anticoagulation and those with coagulation disorders were excluded. The CVC placement was guided by ultrasound and performed by an experienced operator. The 2 study groups were balanced at baseline. The primary outcome was grade 2 to grade 4 catheter-related bleeding within 24 hours after CVC placement (grade 2 = bleeding that required minor intervention; grade 4 = bleeding associated with severe hemodynamic instability). The primary outcome occurred more frequently in the no-transfusion group (11.9% vs 4.8%; relative risk 2.45; 90% CI 1.27 - 4.70) and did not meet noninferiority criteria, defined as an upper boundary of the confidence interval of 3.5. Secondary outcomes, including grade 1 bleeding, exclusively grade 3 or 4 bleeding, and hematoma occurrence, also occurred more frequently in the no-transfusion group. In subgroup analyses, patients with the highest bleeding risk were those in hematology wards, those receiving a tunneled catheter, and those with a platelet count of 10,000 to 20,000 per cubic millimeter.