Department of Emergency Medicine, Fundación Valle del Lili, Cali, Colombia.
Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia.
Acad Emerg Med. 2023 Jun;30(6):644-652. doi: 10.1111/acem.14651. Epub 2023 Jan 27.
Reported risk of bleeding complications after central catheter access in patients with thrombocytopenia is highly variable. Current guidelines recommend routine prophylactic platelet (PLT) transfusion before central venous catheter placement in patients with severe thrombocytopenia. Nevertheless, the strength of such recommendations is weak and supported by observational studies including few patients with very low PLT counts (<20 × 10 /L). This study aims to assess the risk of bleeding complications related to using or not using prophylactic PLT transfusion before ultrasound-guided central venous access in patients with very low PLT counts.
This was a retrospective cohort study of patients with very low PLT counts (<20 × 10 /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 PLT transfusion for the procedure. Multiple imputation by chained equations was used to handle missing data. A two-tailed p < 0.05 was considered statistically significant.
Among 221 patients with very low PLT counts, 72 received prophylactic PLT transfusions while 149 did not. Baseline characteristics were similar between transfused and nontransfused 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 PLT transfusions and those who did not (odds ratio 0.83, 95% confidence interval 0.45-1.55, p = 0.567). Additional complete case and sensitivity analyses yielded results similar to those of the main analysis.
In this single-center retrospective cohort study of ultrasound-guided central venous access in patients with very low PLT counts, no major bleeding was identified, and prophylactic PLT transfusions did not significantly decrease minor bleeding events.
血小板减少症患者中心导管置管后出血并发症的报告风险差异很大。目前的指南建议在严重血小板减少症患者中心静脉置管前常规预防性输注血小板（PLT）。然而，这种建议的强度较弱，并且仅得到包括少数血小板计数极低（<20×10 /L）患者在内的观察性研究的支持。本研究旨在评估在极低血小板计数 (<20×10 /L) 患者中进行超声引导下中心静脉置管时使用或不使用预防性 PLT 输注与出血并发症之间的关系。
这是一项回顾性队列研究，纳入 2011 年 1 月至 2019 年 11 月期间在一所大学医院接受超声引导下中心静脉置管的极低血小板计数 (<20×10 /L) 患者。出血并发症根据不良事件常用术语标准进行分级。采用多变量逻辑回归比较接受和不接受预防性 PLT 输注的患者在主要和次要出血并发症方面的风险。采用链式方程多重插补法处理缺失数据。双侧 p < 0.05 为统计学显著差异。
在 221 例极低血小板计数的患者中，72 例接受预防性 PLT 输注，149 例未接受。输注和未输注患者的基线特征相似。未发现主要出血事件，有 35.7%的患者出现轻微出血事件。多变量逻辑回归分析显示，接受预防性 PLT 输注的患者与未接受的患者之间出血并发症无显著差异（比值比 0.83，95%置信区间 0.45-1.55，p = 0.567）。额外的完整案例和敏感性分析得出的结果与主要分析相似。
在这项对极低血小板计数患者进行超声引导下中心静脉置管的单中心回顾性队列研究中，未发现主要出血事件，预防性 PLT 输注并未显著减少轻微出血事件。
