Plasma transfusions prior to insertion of central lines for people with abnormal coagulation

Abstract

There is only very limited evidence from one RCT to inform the decision whether or not to administer prophylactic plasma prior to central venous catheterisation for people with abnormal coagulation. It is not possible from the current RCT evidence to recommend whether or not prophylactic plasma transfusion is beneficial or harmful in this situation. The three ongoing RCTs will not be able to answer this review's questions, because they are small studies and do not address all of the comparisons included in this review (355 participants in total). To detect an increase in the proportion of participants who had major bleeding from 1 in 100 to 2 in 100 would require a study containing at least 4634 participants (80% power, 5% significance).

Prevention and Management of Bleeding Risk Related to Invasive Procedures in Cirrhosis

“…47 Finally, even if the modern concept of rebalanced hemostasis would support studies including controls not receiving correction of coagulative abnormalities, only very few studies include a real control group. 48 Further studies focusing on bleeding risk stratification (compensated, chronically or acutely decompensated, ACLF) and blood products sparing strategies, beside using comprehensive tests, should include nontransfused controls.…”

Intravascular access devices from an interventional radiology perspective: indications, implantation techniques, and optimizing patency

“…Catheter‐related infection, mainly catheter‐related bacteremia, also can be seen 30 days beyond the initial placement due to frequent access of the catheter, especially in the setting of hemodialysis. The overall rate of catheter‐related bacteremia with TCVCs is reportedly 1.6/1000 catheter days . An in‐depth analysis of catheter‐related infection is beyond the scope of this article.…”

“…It has been reported that the placement of TCVCs in coagulopathic patients with INRs between 1.5 and 2.0 and platelet counts of 25,000 K/cumm to 50,000 K/cumm can be safe even without coagulation product transfusions . Currently, there is no strong evidence recommending prophylactic plasma infusion before catheter placement in patients with abnormal coagulopathy; therefore, this is left to the discretion of the referring clinician and the operating physician . Because the TCVC is an implanted device, TCVCs should not be placed in patients who have systemic infections or are acutely sick (e.g.. patients in the Intensive Care Unit).…”

“…The overall rate of catheter-related bacteremia with TCVCs is reportedly 1.6/1000 catheter days. 12 An in-depth analysis of catheterrelated infection is beyond the scope of this article.…”

The coagulopathy of liver disease: a shift in thinking

“…Cochrane reviewed transfusion of FFP pre-central venous catheter insertion in coagulopathic patients (not specific to cirrhosis), concluding there was insubstantial evidence to guide the use of FFP transfusions prior to insertion of central lines in abnormal coagulation. Only one randomised controlled study met the inclusion criteria for this review (Hall, Estcourt et al 2016). This open-label, randomised trial included 81 critically ill patients with an INR of 1.5-3.…”