Low Levels of Prothrombin Time (INR) and Platelets Do Not Increase the Risk of Significant Bleeding when Placing Central Venous Catheters*

Weigand, Kilian; Encke, Jens; Meyer, F. Joachim; Hinkel, Ulrich-Paul; Munder, Markus; Stremmel, Wolfgang; Zahn, Alexandra

doi:10.1007/s00063-009-1070-2

Cited by 37 publications

(30 citation statements)

References 23 publications

(31 reference statements)

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“…In three of these studies without prophylactic platelet transfusion, thrombocytopenia was identified as a risk factor for local hematoma and oozing. 23,24,41 One study reported no association between thrombocytopenia and minor bleeding complications. 38 In 11 studies, a small group of patients received platelet transfusion.…”

Section: Platelet Countmentioning

confidence: 99%

Central venous catheter placement in coagulopathic patients: risk factors and incidence of bleeding complications

Weerdt¹,

Biemond

Baake³

et al. 2017

Transfusion

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BACKGROUND Central venous catheters are frequently inserted into patients with coagulation disorders. It is unclear whether preprocedural correction of hemostasis is beneficial. We determined the incidence of bleeding complications after central venous catheter placement in patients who had severe coagulopathy and identified potential risk factors for bleeding. STUDY DESIGN AND METHODS The MEDLINE and Cochrane Library databases were systematically searched through November 2015. To be included, articles must have reported on hemorrhagic complications with specification of abnormal coagulation testing results. Severe coagulopathy was defined as a reduced platelet count of 50 × 109/L or less, and/or an elevated international normalized ratio of 1.5 or greater, and/or a partial thromboplastin time of 45 seconds or greater. RESULTS We included one randomized controlled trial and 21 observational studies. In total, there were 13,256 catheter insertions, including 4213 in patients with severe coagulopathy. Before 3150 central venous catheter placements, coagulopathy was not corrected. The bleeding incidence varied from 0 to 32%. The severity of coagulopathy did not predict the risk of bleeding. No study demonstrated a beneficial effect from the prophylactic administration of platelets or fresh‐frozen plasma to prevent bleeding complications. Retrospective observational studies suggested that no preprocedural correction is required up to a platelet count of 20 × 109/L and an international normalized ratio of 3.0. CONCLUSION The incidence of major bleeding complications after central venous catheter placement is low, even in coagulopathic patients. Based on a systematic research of the literature, strong evidence supporting the correction of hemostatic defects before central venous catheter insertion is lacking. However, well‐powered randomized controlled trials will be necessary to determine the minimal platelet count, the maximal international normalized ratio, and an activated partial thromboplastin time that is safe before central venous catheter insertion.

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Section: Platelet Countmentioning

confidence: 99%

Central venous catheter placement in coagulopathic patients: risk factors and incidence of bleeding complications

Weerdt¹,

Biemond

Baake³

et al. 2017

Transfusion

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“…Seventeen observational studies have reported bleeding outcomes in thrombocytopenic patients after insertion of central venous catheters (CVCs) ( Table V). Only one case of severe bleeding (Hb drop >15 g/l) was reported throughout all of these studies (Weigand et al, 2009). Three studies reported on risk factors, in addition to thrombocytopenia, associated with bleeding.…”

Section: Central Venous Cathetersmentioning

confidence: 99%

Guidelines for the use of platelet transfusions

et al. 2016

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“…A delay of CVC insertion waiting for blood products seems to be unjustified, particularly in view of complication rates. 10 Another study has concluded that ultrasound guided central venous cannulation in patients with liver disease and coagulopathy is a safe and is a highly successful modality. In their study, mean INR was 2.17 ± 1.16 whereas median platelet count was 149.5 (range 12-683) × 10 9 /L.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound guided emergency cannulation of internal jugular vein in coagulopathic adult patients a prospective observational pilot study.

Shrestha

Koirala

Gurung

et al. 2017

Bangladesh Crit Care J

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Low Levels of Prothrombin Time (INR) and Platelets Do Not Increase the Risk of Significant Bleeding when Placing Central Venous Catheters*

Cited by 37 publications

References 23 publications

Central venous catheter placement in coagulopathic patients: risk factors and incidence of bleeding complications

Central venous catheter placement in coagulopathic patients: risk factors and incidence of bleeding complications

Guidelines for the use of platelet transfusions

Ultrasound guided emergency cannulation of internal jugular vein in coagulopathic adult patients a prospective observational pilot study.

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Low Levels of Prothrombin Time (INR) and Platelets Do Not Increase the Risk of Significant Bleeding when Placing Central Venous Catheters*

Cited by 37 publications

References 23 publications

Central venous catheter placement in coagulopathic patients: risk factors and incidence of bleeding complications

Central venous catheter placement in coagulopathic patients: risk factors and incidence of bleeding complications

Guidelines for the use of platelet transfusions

Ultrasound guided emergency cannulation of internal jugular vein in coagulopathic adult patients  a prospective observational pilot study.

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Product

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Ultrasound guided emergency cannulation of internal jugular vein in coagulopathic adult patients a prospective observational pilot study.