title: Early platelet dysfunction: an unrecognized role in the acute coagulopathy of trauma.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Surgery, University of Colorado Denver, Denver, CO, USA.
authors.forename: Max V
authors.initials: MV
authors.lastname: Wohlauer
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.forename: Scott
authors.initials: S
authors.lastname: Thomas
authors.forename: Angela
authors.initials: A
authors.lastname: Sauaia
authors.forename: Ed
authors.initials: E
authors.lastname: Evans
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Harr
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Silliman
authors.forename: Victoria
authors.initials: V
authors.lastname: Ploplis
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Castellino
authors.forename: Mark
authors.initials: M
authors.lastname: Walsh
mesh_terms: D000328:Adult; D000368:Aged; D001778:Blood Coagulation Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D001791:Blood Platelet Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000453:epidemiology*; D015999:Multivariate Analysis; D019095:Point-of-Care Systems; D015995:Prevalence; D011446:Prospective Studies; D012771:Shock, Hemorrhagic / Q000453:epidemiology; D013916:Thrombelastography; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000453:epidemiology*; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000453:epidemiology*