Should Patients with Thrombocytopenia Receive Platelets Prior to Central Venous Catheter Placement?

Clinicians who are placing central venous catheters (CVCs) in patients with substantial thrombocytopenia must balance risk for transfusion-related morbidity against the potential benefit of less bleeding. Current guidelines, based on low-quality evidence, have recommended platelet transfusion thresholds in the 20,000 to 50,000/µL range (NEJM JW Gen Med Dec 15 2014 and Ann Intern Med 2015; 162:205).

Researchers in the Netherlands conducted a multicenter trial in 370 patients with severe thrombocytopenia (10,000–50,000 platelets/µL) in intensive care units (ICUs) or hematology wards. Patients were randomized to receive 1 unit of prophylactic platelets or no transfusion prior to ultrasound-guided CVC placement. The primary outcome (catheter-rel…