Safety of Lowering the Platelet Transfusion Threshold Before Central Venous Catheterisation in Patients With Haematological Diseases.

INTRODUCTION

Central venous catheter (CVC) insertion is frequently required in patients with haematological diseases. Despite limited evidence, thrombocytopenia often prompts prophylactic platelet transfusion before catheterisation.

METHODS

We conducted an observational before-and-after study including the first non-tunnelled CVC insertion performed in adult patients with haematological diseases between 2013 and 2026 at the Department of Haematology, Skåne University Hospital, Lund, Sweden. In March 2023, the recommended platelet transfusion threshold before CVC insertion was lowered from < 50 × 109/L to < 10 × 109/L. The primary outcome was the proportion of grade 3-4 bleeding events. Secondary outcomes included the proportion of grade 2 bleeding events and transfusion practices.

RESULTS

A total of 992 patients were included (715 before and 277 after implementation). Grade 3-4 bleeding events occurred in 14/715 procedures before implementation and in none of the 277 insertions after implementation (absolute risk difference -2.0%, 95% CI: -3.3 to -0.4; p = 0.014). Grade 2 bleeding events were unchanged (8.5% vs. 6.5%, absolute risk difference -2.0%, 95% CI: -5.2 to 2.0; p = 0.289). Preprocedural platelet transfusions decreased substantially (30% vs. 6.5%; p < 0.001).

CONCLUSIONS

Lowering the platelet transfusion threshold to < 10 × 109/L was not associated with increased bleeding complications and reduced platelet transfusion use. These findings support a more restrictive preprocedural transfusion strategy.