The Role of Thrombocytopenia in Ventricular Access Device Placement: A Retrospective Cohort Study.

Abstract

Thrombocytopenia (TCP) is common among patients undergoing ventricular access device (VAD) placement. The goal was to characterize the effect of TCP on outcomes following VAD placement. A retrospective chart review was performed among patients who underwent VAD placement at a single center between 2006 and 2024. The patients were divided into 2 cohorts based on a platelet count threshold of 100,000/μL. Thirty-three patients had normal platelet counts (NPC); 12 had TCP. Both had a similar mean age (P = 0.27). TCP was more common among patients with hematologic malignancies (75% vs. 36.4%, P = 0.04). Cerebrospinal fluid (CSF) diversion with VAD was more common in NPC patients (18.2% vs. 0%, P = 0.17). Persistent thrombocytopenia was frequent postoperatively despite transfusion. The mean platelet nadir was 99.8 ± 29.3, 84.7 ± 11.7, and 61.7 ± 29.7 within 24 hours, 72 hours, and 7 days, respectively, among TCP patients. For the same periods, mean platelet count peak was 114.7 ± 25.2, 121.1 ± 28.5, and 125.1 ± 28.9. Hemorrhagic complications occurred in 2 TCP patients (16.7%); no hemorrhagic complications were seen in NPC patients (P = 0.06). The relative risk of hemorrhagic complications attributed to TCP was 13.1 (95% CI: 0.67-254). Infection was more frequent in NPC patients, correlating with a higher proportion requiring CSF diversion. There was no difference in median overall survival between NPC and TCP groups (P = 0.39). Thrombocytopenia is common in the perioperative setting among patients undergoing VAD placement for intraventricular chemotherapy. There is a trend towards increased hemorrhagic complications among patients with TCP. Low postoperative platelet counts were frequently observed despite aggressive platelet transfusion protocols.