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

Lazarevic Lindblad, Mathias LU orcid ; Pålsson, Elin ; Lazarevic, Vladimir LU orcid ; Naddi, Leila LU ; Borgquist, Ola LU ; Nilsson, Lars ; Adrian, Maria LU orcid ; Bark, Björn P LU and Kander, Thomas LU orcid (2026) In European Journal of Haematology
Abstract

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 × 10
9/L to < 10 × 10
9/L. The primary outcome was the proportion of grade 3-4 bleeding events. Secondary outcomes... (More)

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 × 10
9/L to < 10 × 10
9/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 × 10
9/L was not associated with increased bleeding complications and reduced platelet transfusion use. These findings support a more restrictive preprocedural transfusion strategy.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
European Journal of Haematology
publisher
Wiley-Blackwell
external identifiers
  • pmid:42565516
ISSN
1600-0609
DOI
10.1111/ejh.70287
language
English
LU publication?
yes
additional info
© 2026 The Author(s). European Journal of Haematology published by John Wiley & Sons Ltd.
id
61b69756-f526-438e-ab31-2fb025ca51ae
date added to LUP
2026-08-10 05:58:14
date last changed
2026-08-10 08:56:19
@article{61b69756-f526-438e-ab31-2fb025ca51ae,
  abstract     = {{<p>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.</p><p>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 &lt; 50 × 10<br>
 9/L to &lt; 10 × 10 <br>
 9/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.<br>
 </p><p>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 &lt; 0.001).</p><p>CONCLUSIONS: Lowering the platelet transfusion threshold to &lt; 10 × 10 <br>
 9/L was not associated with increased bleeding complications and reduced platelet transfusion use. These findings support a more restrictive preprocedural transfusion strategy.<br>
 </p>}},
  author       = {{Lazarevic Lindblad, Mathias and Pålsson, Elin and Lazarevic, Vladimir and Naddi, Leila and Borgquist, Ola and Nilsson, Lars and Adrian, Maria and Bark, Björn P and Kander, Thomas}},
  issn         = {{1600-0609}},
  language     = {{eng}},
  month        = {{08}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{European Journal of Haematology}},
  title        = {{Safety of Lowering the Platelet Transfusion Threshold Before Central Venous Catheterisation in Patients With Haematological Diseases}},
  url          = {{http://dx.doi.org/10.1111/ejh.70287}},
  doi          = {{10.1111/ejh.70287}},
  year         = {{2026}},
}