12
Treatment
Statement 7
➤ The risk of catheter related complications such as bleeding,
thrombosis, and sepsis are increased in TTP. We did not
systematically search and review the evidence on strategies to reduce
the risk of bleeding around catheter placement. Depending on local
practice and resource availability, procedures to minimize the risk of
bleeding may be considered, including placement by an experienced
clinician, ultrasound guided placement, and internal jugular vein or
femoral vein access (rather than subclavian vein access). Once the
platelet count increases and the patient is stable, clinicians usually
regularly review whether lines need to be changed and whether
venous thromboembolism prophylaxis should be considered.
Statement 8
➤ We did not systematically search and review the evidence on the
beneficial or harmful effects of platelet transfusions in TTP. Platelet
transfusions are usually avoided and considered unnecessary in
most cases of TTP. However, platelet transfusion is often carried
out before a correct diagnosis of TTP has been made. There are
case reports in TTP patients of the association between platelet
transfusions and arterial thrombosis, clinical deterioration and
increased relapse rate. However, the causative role of platelet
transfusion is not clear. In general, prophylactic platelet transfusions
are avoided in non- bleeding TTP patients, as their effect is not
clear, and they carry the potential risk of adverse events, especially
when transfusions are repeated. However, platelet transfusions are
sometimes used in TTP patients with serious bleeding, or in TTP
patients undergoing invasive procedures with a high risk of bleeding.
Platelet transfusions are usually not used to reduce the risk of
bleeding during central line placement. However, whether platelet
transfusion should be performed prior to central line placement
depends on the experience of the individual placing the line and the
patient's overall bleeding risk.
Statement 9
➤ Based on indirect evidence in other critically ill patients, patients
with TTP usually receive venous thromboemobolism (VTE)
prophylaxis. Nonpharmacologic VTE prophylaxis (i.e., ambulation as
tolerated, graduated compression stockings, intermittent pneumatic
compression devices) is usually used while the platelet count is <50
× 109/L. Once the platelet count is >50 × 109/L, pharmacologic
VTE prophylaxis such as low molecular weight heparin should be
considered.
