PB1227 - Platelet transfusion better preserves ROTEM clot strength and thrombin generation: a case-control study

Tuesday, July 12, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Andrea Rossetto, MD

Clinical Research Fellow / PhD Student
Queen Mary Univeristy of London, UK
London, England, United Kingdom

Co-Author(s)

PV

Paul Vulliamy

Clinical Lecturer
Blizard Institute, Queen Mary University of London
London, England, United Kingdom
LG

Laura Green

Senior Clinical Lecturer in Transfusion Research/Innovation - Consultant in Haemostasis/Transfusion
Queen Mary Univeristy of London, UK - Barts Health NHS Trust, London, UK
London, England, United Kingdom
Ross A. Davenport, PhD FRCS

Senior Lecturer in Trauma Sciences and Consultant Trauma & Vascular Surgeon
Centre for Trauma Science, Queen Mary Univeristy of London, UK - Barts Health NHS Trust, London, UK
London, England, United Kingdom

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.