Contribution of Coagulopathy on the Risk of Bleeding After Central Venous Catheter Placement in Critically Ill Thrombocytopenic Patients

Abstract

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Year in Review 2023: Noteworthy Literature in Cardiothoracic Critical Care

“…Patients with unwitnessed cardiac arrest, initial presenting rhythm of asystole, or more than 3 hours from ROSC at enrollment were excluded. Study participants were randomized to 24 hours of mild hypercapnia (PaCO 2 50-55 mmHg) or normocapnia (PaCO 2 [35][36][37][38][39][40][41][42][43][44][45]. Despite achieving adequate separation in PaCO 2 values between groups, targeted mild hypercapnia did not result in improved neurologic outcomes at 6 months, the study's primary outcome (43.5% vs 44.6%, RR .98 [95% CI, .87-1.11]).…”

“…Inclusion criteria included thrombocytopenia with platelet count 10-50 × 10 9 /L within 24 hours of CVC insertion, and CVCs were required to remain in place for at least 24 hours. Exclusion criteria were therapeutic anticoagulation, coagulation factor deficiency (either congenital or acquired), a spontaneously prolonged international normalized ratio (INR) greater than 1.5 (the trial protocol was increased to greater than 3.0 for the last third of study participants following the results of a study demonstrating similar safety profile with CVC insertion with higher INR), 44 or multiple CVC placement episodes if episodes occurred within 24 hours of the prior CVC placement. There was no limitation on the type of catheter used, including dialysis catheters, and they could be tunneled or non-tunneled.…”

Bleeding assessment following central venous catheter placement, a direct comparison of prospective and retrospective analyses

“…In the ICU of one of the centers participating in the PACER trial (Amsterdam UMC location University of Amsterdam), CVC-related bleeding was evaluated in a retrospective observational cohort study. 4 All CVC placements, between February 2016 and February 2020 in patients with platelet counts below 50 x 10 9 /L, were included. Two assessors independently reviewed the medical charts of included patients to find bleeding that occurred within 24 h of CVC placement.…”

“…3 In a subgroup of patients, enrolled at the ICU at one of the participating centers, an additional retrospective chart review was performed to assess CVC-related bleeding using the same bleeding score. 4 This allowed us to directly compare three different methods of bleeding assessment, using the same bleeding definition in the same patients. We hypothesized that the incidence of major bleeding would be similar between the different methods, but the incidence of minor bleeding would be higher in the prospectively collected clinical bleeding assessment.…”

Anesthetic challenges in ruptured ovarian cyst with supratherapeutic international normalized ratio in patient a with artificial mitral valve

“…[ 4 ] A recent study reported that coagulopathy was not associated with an increased risk of bleeding for ultrasound-guided CVP catheter placement. [ 5 ] To conclude, the patients in supratherapeutic INR level with life-threatening bleeding should be controlled by immediately available medication and blood product, and also think of risk-benefit ratio for reversal of warfarin in an emergency condition.…”