Early platelet dysfunction: an unrecognized role in the acute coagulopathy of trauma. J Am Coll Surg 2012 May;214(5):739-46
Date
04/24/2012Pubmed ID
22520693Pubmed Central ID
PMC3348700DOI
10.1016/j.jamcollsurg.2012.01.050Scopus ID
2-s2.0-84860109399 (requires institutional sign-in at Scopus site) 264 CitationsAbstract
BACKGROUND: Our aim was to determine the prevalence of platelet dysfunction using an end point of assembly into a stable thrombus after severe injury. Although the current debate on acute traumatic coagulopathy has focused on the consumption or inhibition of coagulation factors, the question of early platelet dysfunction in this setting remains unclear.
STUDY DESIGN: Prospective platelet function in assembly and stability of the thrombus was determined within 30 minutes of injury using whole blood samples from trauma patients at the point of care using thrombelastography-based platelet functional analysis.
RESULTS: There were 51 patients in the study. There were significant differences in the platelet response between trauma patients and healthy volunteers, such that there was impaired aggregation to these agonists. In trauma patients, the median ADP inhibition of platelet function was 86.1% (interquartile range [IQR] 38.6% to 97.7%) compared with 4.2 % (IQR 0 to 18.2%) in healthy volunteers. After trauma, the impairment of platelet function in response to arachidonic acid was 44.9% (IQR 26.6% to 59.3%) compared with 0.5% (IQR 0 to 3.02%) in volunteers (Wilcoxon nonparametric test, p < 0.0001 for both tests).
CONCLUSIONS: In this study, we show that platelet dysfunction is manifest after major trauma and before substantial fluid or blood administration. These data suggest a potential role for early platelet transfusion in severely injured patients at risk for postinjury coagulopathy.
Author List
Wohlauer MV, Moore EE, Thomas S, Sauaia A, Evans E, Harr J, Silliman CC, Ploplis V, Castellino FJ, Walsh MMESH terms used to index this publication - Major topics in bold
AdultAged
Blood Coagulation Disorders
Blood Platelet Disorders
Comorbidity
Female
Humans
Male
Middle Aged
Multiple Trauma
Multivariate Analysis
Point-of-Care Systems
Prevalence
Prospective Studies
Shock, Hemorrhagic
Thrombelastography
Trauma Severity Indices
Wounds, Nonpenetrating
Wounds, Penetrating
