Withholding prophylactic platelet transfusion did not meet noninferiority in patients with severe thrombocytopenia
By Elana Gotkine HealthDay Reporter
FRIDAY, May 26, 2023 (HealthDay News) — For patients with severe thrombocytopenia, withholding of prophylactic platelet transfusion before ultrasound-guided placement of a central venous catheter (CVC) results in more CVC-related bleeding events than prophylactic platelet transfusion, according to guidelines published in the May 25 issue of the New England Journal of Medicine.
Floor L.F. van Baarle, M.D., from the University of Amsterdam, and colleagues conducted a multicenter, randomized, noninferiority trial involving patients with severe thrombocytopenia (platelet count, 10,000 to 50,000 per mm3) who were treated on the hematology ward or the intensive care unit. Participants were randomly assigned to receive one unit of prophylactic platelet transfusion or no platelet transfusion before ultrasound-guided CVC placement. The per-protocol primary analysis included 373 episodes of CVC placement involving 338 patients. The noninferiority margin was an upper boundary of 3.5 for the 90 percent confidence interval of relative risk.
The researchers found that catheter-related bleeding of grade 2 to 4 occurred in 4.8 and 11.9 percent of patients in the transfusion and no-transfusion groups, respectively (relative risk, 2.45; 90 percent confidence interval, 1.27 to 4.70), and catheter-related bleeding of grade 3 or 4 occurred in 2.1 and 4.9 percent, respectively (relative risk, 2.43; 95 percent confidence interval, 0.75 to 7.93). Overall, there were 15 adverse events reported: 13 were categorized as serious. The net savings were $410 per catheter placement for withholding prophylactic platelet transfusion before CVC placement.
“The noninferiority of withholding transfusion was not shown for the primary outcome of grade 2 to 4 bleeding,” the authors write.
The study was funded by ZonMw.
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