In patients with severe thrombocytopenia receiving placement of a central venous catheter (CVC), a study showed that withholding prophylactic platelet transfusions was associated with a higher frequency of CVC-related bleeding events than seen with use of prophylactic platelet transfusions. Study results were published in the New England Journal of Medicine.
This multicenter study was a noninferiority trial evaluating the use or withholding of prophylactic platelet transfusion prior to CVC placement in patients with severe thrombocytopenia, which was defined as having a platelet count between 10,000/mm3 and 50,000/mm3. Patients were randomly assigned 1:1 to receipt or withholding of prophylactic platelet transfusion, which involved administration of 1 unit of platelet concentrate.
The study had a primary outcome of catheter-related bleeding events of grade 2 to 4 within 24 hours following CVC placement. A key secondary outcome was bleeding events of grade 3 or 4, with additional outcomes also evaluated.
The per-protocol primary analysis of this study included 338 patients, among whom there were 373 CVC placement events. The median age was 58 years in the 188 patients of the group receiving prophylactic transfusions (transfusion group), and it was 59 years in the group of 185 patients not receiving transfusions. The median platelet counts were 30,000 mm3 (interquartile range [IQR], 20,000-38,000) in the transfusion group and 30,000 mm3 (IQR, 20,000-37,000) in the group not receiving transfusions.
The transfusion group had a rate of catheter-related bleeding of grade 2 to 4 of 4.8%, compared with 11.9% in the group not receiving transfusions (relative risk [RR], 2.45; 90% CI, 1.27-4.70).
Rates of catheter-related bleeding events of grades 3 or 4 were 2.1% for the group receiving transfusions and 4.9% for those not receiving transfusions (RR, 2.43). There were serious adverse events reported in 13 patients overall, which were all catheter-related bleeding events. These occurred in 4 patients of the transfusion group and in 9 patients of the group not receiving transfusions.
The net cost savings associated with withholding prophylactic platelet transfusions was also calculated. This was estimated to amount to $410 per catheter placement.
“In patients with severe thrombocytopenia, we found that withholding prophylactic platelet transfusion before CVC placement in those 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 than prophylactic platelet transfusion,” the study investigators wrote in their report.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of disclosures.
This article originally appeared on Hematology Advisor
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. doi:10.1056/NEJMoa2214322