Thoracentesis in advanced cancer patients with severe thrombocytopenia: Ultrasound guide improves safety and reduces bleeding risk

Orlandi, Elena; Citterio, Chiara; Seghini, Pietro; Nunzio, Camilla Di; Mordenti, Patrizia; Cavanna, Luigi

doi:10.1111/crj.12739

Cited by 12 publications

(5 citation statements)

References 29 publications

(29 reference statements)

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“…Similar nonrandomized data exist for paracentesis (56,(72)(73)(74) and thoracentesis (53,(75)(76)(77)(78). The pooled data on patients with abnormal coagulation profiles (INR > 1.5 and/or platelet count < 50 Â 10 9 /L) indicate a very low risk of major bleeding for paracentesis (0.2%, 5 of 2,113 patients) (56,(72)(73)(74) and thoracentesis (0.5%, 7 of 1,505 patients) (75)(76)(77)(78). Other retrospective reviews on thoracentesis suggest similar results: 17 bleeding-related complications after thoracentesis in 9,320 patients (0.18%), all of which occurred in patients with platelet counts > 50 Â 10 9 /L (53); and no bleeding complications after thoracentesis in 32 patients with an INR > 3.0 (77).…”

Section: Laboratory Parameters For Low Bleeding Risk Proceduresmentioning

confidence: 68%

Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations

Patel

Rahim

Davidson

et al. 2019

Journal of Vascular and Interventional Radiology

369

285

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AASLD ¼ American Association for the Study of Liver Disease, aPTT ¼ activated partial thromboplastin time, CI ¼ confidence interval, CVC ¼ central venous catheter, DAPT ¼ dual antiplatelet therapy, DOAC ¼ direct oral anticoagulant, DVT ¼ deep vein thrombosis, FFP ¼ fresh frozen plasma, INR ¼ International Normalized Ratio, LMWH ¼ low molecular weight heparin, NVAF ¼ nonvalvular atrial fibrillation, PEG ¼ percutaneous endoscopic gastrostomy, PT ¼ prothrombin time, RCT ¼ randomized controlled trial, VKA ¼ vitamin K antagonist, VTE ¼ venous thromboembolism

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Section: Laboratory Parameters For Low Bleeding Risk Proceduresmentioning

confidence: 68%

Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations

Patel

Rahim

Davidson

et al. 2019

Journal of Vascular and Interventional Radiology

369

285

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“…Our data demonstrate that in a large number of cancer patients: 1,867 underwent 2,187 US-guided insertional procedures no pneumothorax were reported, in addition, between the 110 thrombocytopenic cancer patients, that underwent US-guided CVC insertion, only one patient showed a local mild hematoma, without clinical significance, no patients of this series received prophylactic platelet transfusion to prevent bleeding of CVC insertional procedure. Other invasive procedures such as thoracentesis in thrombocytopenic cancer patients may be safety done under US-guidance, without prophylactic platelet transfusion as recently reported by our group (30), and other report confirm that US-guided CVC is a safe and highly successful modality also in liver disease patients with damaged coagulation (31). A prospective, randomized controlled trial powered to test the hypothesis of whether omitting forgoing platelet transfusion prior to US-guided CVC insertion leads to an equal occurrence of clinically relevant bleeding complications in patients with thrombocytopenia is currently recruiting (32).…”

Section: Cancer Patients In Cancer Patients In Resultsmentioning

confidence: 75%

Central venous catheterization in cancer patients with severe thrombocytopenia: Ultrasound‑guide improves safety avoiding prophylactic platelet transfusion

et al. 2020

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Prior research has revealed that ultrasound (US) guided central venous catheterization (CVC) is associated with a reduction in the complication rate such as pneumothorax and an improved first-pass success placing CVC in the internal jugular vein. The present study investigated if US-guided CVC, in a subset of cancer patients with severe thrombocytopenia, reduced bleeding risk and avoided prophylactic platelet transfusion. The efficacy and safety of US-guided CVC placement in cancer patients with severe thrombocytopenia was retrospectively analyzed over a period of 9 years (Dec 2000-Jan 2009), 1,660 and 207 patients with cancer underwent US-guided CVC placement into internal jugular vein respectively at the Department of Onco-Haematology, Hospital of Piacenza. The first group of patients included patients in active antitumor treatment, while the second group included patients in the palliative phase. A total of 110 (5.89%) of these 1,867 patients exhibited severe thrombocytopenia defined as platelet count ≤20x10 9 /l, and formed the basis of this study. All procedures were evaluated for bleeding complications as defined by the National Institute of Health Common Terminology Criteria for Adverse Events (CTCAE 3.0). In the subgroup of the 110 patients with severe thrombocytopenia a single needle puncture of the vein was employed in 121 of the 122 procedures (99.18%) and no attempt failures were registered. No pneumothorax, no major bleeding and no nerve and arterial puncture were reported, only one self-limiting hematoma (0.90%) at the site of CVC insertion was reported (CTCAE 3.0 grade 1). No platelet transfusions were performed in the 110 patients, pre and post CVC placement. We believe that US-guided CVC insertion procedures into the internal jugular vein makes the difference in safety, also in thrombocytopenic patients avoiding prophylactic or post procedure platelet transfusion.

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“…Of these, 42 studies focused on other topics, for example, efficacy/safety trials of different antineoplastic treatments. 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Thirty-three studies aimed to investigate the association between platelet counts and bleeding but could not be included, as no bleeding events occurred during the study period. 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 Thus, 52 studies were included for...…”

Section: Resultsmentioning

confidence: 99%

The Role of Platelets in Cancer-Related Bleeding Risk: A Systematic Review

Larsen

Højbjerg

Hvas

2019

Semin Thromb Hemost

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Cancer patients face an elevated risk of bleeding, and here platelets play a pivotal role. The association between platelet count and bleeding, as well as safe thresholds for prophylactic platelet transfusion, is described mainly in hematological malignancies, and knowledge is sparse for patients with solid tumors. Platelet function tests may further improve bleeding risk assessment in cancer patients. This study provides a systematic review of the available literature on associations between platelet count and/or function and bleeding in adult cancer patients. The review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. PubMed, Embase, and Web of Science were searched up to August 2019. The National Heart, Lung, and Blood Institute's tools were used for quality assessment. In total, 52 studies investigated associations between bleeding and platelet count (n = 40) or function (n = 12) in patients with hematological malignancy (n = 31), solid tumors (n = 11), or both (n = 10). The majority of included studies rated good (n = 23) or fair (n = 25). The association between platelet count and bleeding was most pronounced at platelet counts ≤ 10 × 109/L but was less evident for solid tumors. Overall, reduced platelet function was significantly associated with bleeding risk. Thus, the available evidence supports current guidelines for prophylactic platelet transfusions at platelet count ≤ 10 × 109/L in hematological cancer patients, whereas more evidence is needed in patients with solid tumors. Platelet function analysis may be valuable in assisting bleeding risk assessment in cancer patients but is sparsely investigated so far.

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Thoracentesis in advanced cancer patients with severe thrombocytopenia: Ultrasound guide improves safety and reduces bleeding risk

Abstract: US guided thoracentesis is a safe and effective approach in cancer patients with severe thrombocytopenia. Our results indicate that this procedure, when US-guided, can be safety performed even in patients with platelet count below 30 × 10 /L.

Cited by 12 publications

References 29 publications

Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations

Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations

Central venous catheterization in cancer patients with severe thrombocytopenia: Ultrasound‑guide improves safety avoiding prophylactic platelet transfusion

The Role of Platelets in Cancer-Related Bleeding Risk: A Systematic Review

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