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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*

Ein niedriger Quick und eine Thrombopenie erhöhen nicht das Blutungsrisiko bei der Anlage eines zentralvenösen Katheters

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Abstract

Background and Purpose:

Central venous catheters are frequently placed in intensive care medicine for multiple indications. The risk of severe bleeding after cannulation is considered to be increased in patients with abnormal coagulation, common in critically ill patients.

Patients and Methods:

This open prospective trial, performed at two medical intensive care units and one hematology intermediate care ward, investigated whether insertion of a central venous catheter in patients with coagulopathy (prothrombin time ≤ 50% [International Normalized Ratio, INR, ≥ 1.5] and/or platelets ≤ 50 × 109/l) bears an increased risk of bleeding.

Results:

In 196 patients with and without severe disorders of hemostasis, no significant difference in decrease of hemoglobin after catheter placement was observed. In addition, no correlation between a significant drop in hemoglobin and increased levels of creatinine or urea was seen. Mechanical complications were similar in frequency compared to previous publications.

Conclusion:

These findings demonstrate that coagulation disorders with altered prothrombin time (INR) or platelets do not increase the risk of significant bleeding when inserting a central venous catheter. Therefore, the prophylactic correction of coagulation by transfusion of blood products or coagulation factors is not necessary before central venous catheter insertion.

Zusammenfassung

Hintergrund und Ziel:

Zentralvenöse Katheter werden in der Intensivmedizin häufig und für viele verschiedene Indikationen benötigt. Man geht davon aus, dass bei Patienten mit schlechter Gerinnung das Blutungsrisiko bei der Anlage solcher Katheter erhöht ist. Verminderte Gerinnungswerte finden sich aber häufig bei kritisch Kranken.

Patienten und Methodik:

Diese offene und prospektive Studie untersuchte, ob Patienten mit einer eingeschränkten Gerinnung (Quick ≤ 50% [Inter national Normalized Ratio, INR, ≥ 1,5] und/oder Thrombozytenzahl ≤ 50 × 109/l) tatsächlich ein erhöhtes Blutungsrisiko bei der Anlage zentralvenöser Katheter aufweisen. Durchgeführt wurde die Studie auf zwei internistischen Intensivstationen und einer hämatologischen Wachstation. Es wurden 196 Patienten mit und ohne eingeschränkte Gerinnungswerte untersucht und verglichen.

Ergebnisse:

Im Vergleich von Patienten mit eingeschränkter Gerinnung und solchen ohne fand sich kein signifikanter Unterschied im Hinblick auf einen Abfall des Serumhämoglobins nach der Anlage eines zentralvenösen Katheters. Es fand sich ferner auch kein signifikanter Zusammenhang eines Hämoglobinabfalls mit erhöhten Serumkreatinin- oder -harnstoffwerten. Die Anzahl der aufgetretenen mechanischen Komplikationen war vergleichbar mit früheren Studien.

Schlussfolgerung:

Diese Daten zeigen, dass eine Störung der Gerinnungsaktivität aufgrund eines verminderten Quick-Werts (erhöhten INR-Werts) oder einer verminderten Thrombozytenzahl bei der Anlage eines zentralvenösen Katheters nicht mit einem erhöhten Blutungsrisiko assoziiert ist. Daher ist die prophylaktische Optimierung der Gerinnungsparameter durch Gabe von Transfusionen vor der Anlage eines zentralvenösen Katheters nicht notwendig.

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Authors and Affiliations

  1. Medizin IV, Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, Germany

    Kilian Weigand MD, Jens Encke, Wolfgang Stremmel & Alexandra Zahn

  2. Johanna-Etienne-Krankenhaus, Neuss, Germany

    Jens Encke

  3. Medizin III, Department of Cardiology and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany

    F. Joachim Meyer

  4. Department of Nephrology, University Hospital Heidelberg, Heidelberg, Germany

    Ulrich Paul Hinkel

  5. Medizin V, Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany

    Markus Munder

  6. Medizin IV, Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Kilian Weigand MD

Authors
  1. Kilian Weigand MD
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  2. Jens Encke
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  3. F. Joachim Meyer
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  4. Ulrich Paul Hinkel
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  5. Markus Munder
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  6. Wolfgang Stremmel
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  7. Alexandra Zahn
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Correspondence to Kilian Weigand MD.

Additional information

*Trial registration: ClinicalTrials.gov NCT00448188.

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Weigand, K., Encke, J., Meyer, F.J. et al. Low Levels of Prothrombin Time (INR) and Platelets Do Not Increase the Risk of Significant Bleeding when Placing Central Venous Catheters*. Med Klin 104, 331–335 (2009). https://doi.org/10.1007/s00063-009-1070-2

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  • DOI: https://doi.org/10.1007/s00063-009-1070-2

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