Thrombocytopenia & CVC Placement: What’s the Platelet Count Threshold to Transfuse?

Your patient has thrombocytopenia (low platelet count) but also needs a central line (CVC).
We do not want to do harm to our patient and cause them a bleeding complication.
But what is the magic platelet count to safely perform the procedure?
The authors performed a multicenter randomized controlled trial with 338 patients to find out.
Hat tip to the authors. Read these data for yourself.
If patients platelet count was between 10000 to 50000, they were randomized to receive a unit of platelets or a bunch of nothing.
Their outcomes were driven around bleeding complications.
Well, they found out that patients who received the platelets prior to the CVC placement had less bleeding.
They used bleeding grades to define outcomes.
For the primary outcome, the number needed to treat to avoid a grade 2 to 4 bleed was 14.
A subgroup analysis was performed to help tease out a more nuanced approach but nothing really yells at me.
What this study is telling me is that we all need to go donate platelets because the demand is going to skyrocket.
How is this going to change your practice?
Does your cardiogenic shock patient need a PAC? Click here to find out.

Citation for CVC placement & low platelet count

van Baarle FLF, van de Weerdt EK, van der Velden WJFM, Ruiterkamp RA, Tuinman PR, Ypma PF, van den Bergh WM, Demandt AMP, Kerver ED, Jansen AJG, Westerweel PE, Arbous SM, Determann RM, van Mook WNKA, Koeman M, Mäkelburg ABU, van Lienden KP, Binnekade JM, Biemond BJ, Vlaar APJ. Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia. N Engl J Med. 2023 May 25;388(21):1956-1965. doi: 10.1056/NEJMoa2214322. PMID: 37224197.
Link to Article

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