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      It’s About Time: Transfusion Effects on Post-Injury Platelet Aggregation Over Time

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          Abstract

          Background

          Impaired post-injury platelet aggregation is common, but the effect of transfusion on this remains unclear. Data suggests that following injury platelet transfusion may not correct impaired platelet aggregation and impaired platelet aggregation may not predict the need for platelet transfusion. We sought to further investigate platelet aggregation responses to transfusions, using regression statistics to isolate the independent effects of transfusions given in discrete time intervals from injury on both immediate and longitudinal platelet aggregation. We hypothesized that platelet aggregation response to platelet transfusion increases over time from injury.

          Methods

          Serial (0–96h) blood samples were collected from 248 trauma patients. Platelet aggregation was assessed in vitro with impedance aggregometry stimulated by adenosine diphosphate (ADP), collagen, and thrombin receptor-activating peptide-6 (TRAP). Using regression, transfusion exposure was modeled against platelet aggregation at each subsequent timepoint and adjusted for confounders (injury severity [ISS], INR, base deficit, platelet count, and interval transfusions). The expected change in platelet aggregation at each timepoint under the intervention of transfusion exposure was calculated and compared to the observed platelet aggregation.

          Results

          The 248 patients analyzed were severely injured (ISS 21 +/− 19), with normal platelet counts (mean 268×10 9/L +/−90), and 62% were transfused in 24 hours. The independent effect of transfusions on subsequent platelet aggregation over time was modeled with observed platelet aggregation under hypothetical treatment of one unit transfusion of blood, plasma, or platelets. Platelet transfusions had increasing expected effects on subsequent platelet aggregation over time, with the maximal expected effect occurring late (4–5 days from injury).

          Conclusions

          Controversy exists on whether transfusions improve impaired post-injury platelet aggregation. Using regression modeling, we identified that expected transfusion effects on subsequent platelet aggregation are maximal with platelet transfusion given late after injury. This is critical for tailored resuscitation, identifying a potential early period of resistance to platelet transfusion that resolves by 96 hours.

          Level of Evidence

          IV

          Study Type

          Prognostic

          Related collections

          Author and article information

          Journal
          101570622
          39901
          J Trauma Acute Care Surg
          J Trauma Acute Care Surg
          The journal of trauma and acute care surgery
          2163-0755
          2163-0763
          31 July 2019
          November 2019
          01 November 2020
          : 87
          : 5
          : 1042-1051
          Affiliations
          [1 ]Department of Surgery, Zuckerberg San Francisco General Hospital and the University of California, San Francisco; San Francisco, California
          [2 ]Department of Medicine, San Francisco General Hospital and the University of California, San Francisco; San Francisco, California
          [3 ]Department of Surgery, Denver Health Medical Center and the University of Colorado; Denver, Colorado
          Author notes

          AUTHOR CONTRIBUTIONS:

          LZK, AD, ASC, RAC, and MJC contributed to study design, data collection, data analysis, data interpretation, writing, and clinical revision.

          CMH, AJR, and ATF contributed to data interpretation, writing, and clinical revision

          Corresponding author: Lucy Z Kornblith, MD, Zuckerberg San Francisco General Hospital, 1001 Potrero Avenue, Bldg. 1, Ste. 210, Box 1302, San Francisco, CA 94110, lucy.kornblith@ 123456ucsf.edu , Phone: (415) 206-6946, Fax: (415) 206-5484
          Article
          PMC6814558 PMC6814558 6814558 nihpa1536154
          10.1097/TA.0000000000002459
          6814558
          31389915
          faab83f1-fb4b-4aa1-b24f-e73714201fc1
          History
          Categories
          Article

          hemorrhage,platelet transfusion,wounds and injury
          hemorrhage, platelet transfusion, wounds and injury

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