Dr Baron1 has presented a balanced argument in the debate about repairing coagulopathy prior to central venous line insertion. There are many points on which we agree.
First, the literature and evidence favoring reversal of a laboratory coagulopathy are thin and essentially nonexistent. As shown in Dr Baron’s Table 1,1 laboratory-defined coagulation abnormalities did not predict procedural complications in the Della Vigna et al2 study from Italy or the Weigand et al4 study from Germany. In the Theodoro et al4 study from the United States, patients with end-stage renal disease have more procedural complications with central venous line insertion than other patients, but there is no way to infuse a “repair agent” to reverse renal failure. The Tercan et al4 study from Turkey showed there were more complications when inserting central venous lines in patients with an international normalized ratio (INR)>1.5, but these investigators did not provide even a shred of evidence to support the notion that reversal agents could lower the complication rate.