title: Platelet function following trauma. A multiple electrode aggregometry study.
abstract: Platelets play a central role in coagulation. Currently, information on platelet function following trauma is limited. We performed a retrospective analysis of patients admitted to the emergency room (ER) at the AUVA Trauma Centre, Salzburg, after sustaining traumatic injury. Immediately after admission to the ER, blood was drawn for blood cell counts, standard coagulation tests, and platelet function testing. Platelet function was assessed by multiplate electrode aggregometry (MEA) using adenosine diphosphate (ADPtest), collagen (COLtest) and thrombin receptor activating peptide-6 (TRAPtest) as activators. The thromboelastometric platelet component, measuring the contribution of platelets to the elasticity of the whole-blood clot, was assessed using the ROTEM device. The study included 163 patients, 79.7% were male, and the median age was 43 years. The median injury severity score was 18. Twenty patients (12.3%) died. Median platelet count was significantly lower among non-survivors than survivors (181,000/μl vs. 212,000/μl; p=0.01). Although platelet function defects were relatively minor, significant differences between survivors and non-survivors were observed in the ADPtest (94 vs. 79 U; p=0.0019), TRAPtest (136 vs. 115 U; p<0.0001), and platelet component (134 vs.103 MCEEXTEM - MCEFIBTEM; p=0.0012). Aggregometry values below the normal range for ADPtest and TRAPtest were significantly more frequent in non-survivors than in survivors (p=0.0017 and p=0.0002, respectively). Minor decreases in platelet function upon admission to the ER were a sign of coagulopathy accompanying increased mortality in patients with trauma. Further studies are warranted to confirm these results and investigate the role of platelet function in trauma haemostatic management.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Centre, Salzburg, Austria.
authors.forename: Cristina
authors.initials: C
authors.lastname: Solomon
authors.forename: Stefan
authors.initials: S
authors.lastname: Traintinger
authors.forename: Bernhard
authors.initials: B
authors.lastname: Ziegler
authors.forename: Alexander
authors.initials: A
authors.lastname: Hanke
authors.forename: Niels
authors.initials: N
authors.lastname: Rahe-Meyer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Voelckel
authors.forename: Herbert
authors.initials: H
authors.lastname: Schöchl
mesh_terms: D000244:Adenosine Diphosphate / Q000494:pharmacology; D000328:Adult; D001317:Austria / Q000453:epidemiology; D003094:Collagen / Q000494:pharmacology; D004566:Electrodes; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000494:pharmacology; D010974:Platelet Aggregation / Q000187:drug effects; D010976:Platelet Count; D010979:Platelet Function Tests / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D013916:Thrombelastography; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000097:blood* / Q000401:mortality
chemical_list: D010446:Peptide Fragments; C082835:thrombin receptor peptide (42-47); D000244:Adenosine Diphosphate; D003094:Collagen