Abstract Number: PB1227
Meeting: ISTH 2022 Congress
Theme: Platelet Disorders, von Willebrand Disease and Thrombotic Microangiopathies » Platelet Function Disorders, Acquired
Background: Platelet transfusion improve clinical haemostasis and reduce mortality due to bleeding, yet the mechanism of how this is achieved remains unknown. ¬
Aims: Determine the haemostatic benefit of current platelet transfusion in bleeding trauma patients.
Methods: Secondary analysis of previously collected data from adult trauma patients enrolled into an ongoing prospective cohort study (ISRCTN12962642) at a UK major trauma center between 2008 and 2020. Blood samples were drawn in the emergency department and at intervals after 4, 8 and 12 units of red blood cells. Tissue factor-activated rotational thromboelastometry with cytochalasin D (FIBTEM) and without (EXTEM) were performed with fresh whole blood. Plasmin-antiplasmin complex levels (PAP) were quantified by enzyme-linked immunosorbent assay in stored plasma. Resuscitation intervals during which platelets were and were not transfused were matched 1:1 based on interval type (0hr-4units, 4units-8units, 8units-12units), interval duration, prior platelet transfusions, and amount of co-administered fresh frozen plasma (FFP) and cryoprecipitate.
Results: 313 resuscitation intervals from 223 trauma patients were analysed, 207 with and 106 without platelet transfusion. Platelet-transfused intervals had wider time gap from injury (p < 0.001), lasted longer (p < 0.001) and were characterised by a larger co-administration of other pro-haemostatic components (FFP, p < 0.001; cryoprecipitate, p < 0.001). Following case-control matching, 40 intervals in each group were analysed. Haemostasis was better persevered at the end of platelet transfusion intervals as measured by EXTEM – FIBTEM A5 (28 vs 22 mm, p=0.021), EXTEM A5 (37 vs 28 mm, p=0.020), EXTEM clot formation time (110 vs 182 sec, p=0.022) and EXTEM maximum velocity (12 vs 8 mm*min, p=0.015) (Figure 1A-B-D-E). There was no difference in EXTEM maximum lysis (p=0.449), PAP levels (p=0.190) and platelet count (p=0.199).
Conclusion(s): Platelet transfusion is associated with a larger platelet contribution to early clot strength and thrombin generation, but not platelet count or decreased fibrinolysis.
Image 1
Figure 1. ROTEM parameters, plasmin-antiplasmin complex levels and platelet count in matched resuscitation intervals. No PLT, intervals in which platelet transfusion were not administered; PLT, intervals in which platelet transfusion were administered. Box-whisker plots are plotted according to Tukey’s method without outliers. Dotted lines represent previously identified cut-off for platelet dysfunction -EXTEM – FIBTEM A5 <= 30mm- and coagulopathy -EXTEM A5 <= 40mm-. Statistical comparisons performed with paired Wilcoxon signed-rank tests. EXTEM, tissue factor-activated ROTEM; FIBTEM, tissue factor-activated ROTEM plus cytochalasin D; A5, clot amplitude at 5 minutes; CT, clot time; CFT, clot formation time; MaxVel, maximum velocity; ML, maximum lysis; PAP, plasmin-antiplasmin complex; PLT, platelets.
To cite this abstract in AMA style:
Rossetto A, Vulliamy P, Green L, Davenport R. Platelet transfusion better preserves ROTEM clot strength and thrombin generation: a case-control study [abstract]. https://abstracts.isth.org/abstract/platelet-transfusion-better-preserves-rotem-clot-strength-and-thrombin-generation-a-case-control-study/. Accessed October 1, 2023.« Back to ISTH 2022 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/platelet-transfusion-better-preserves-rotem-clot-strength-and-thrombin-generation-a-case-control-study/