Dynamics of Platelet Counts in Major Trauma: The Impact of Haemostatic Resuscitation and Effects of Platelet Transfusion—A Sub-Study of the Randomized Controlled RETIC Trial
Although platelets play a central role in haemostasis, the dynamics of platelet counts during haemostatic resuscitation, the response to platelet transfusion, and effects on clinical outcome are poorly described for trauma patients. As a sub-study of the already published randomized controlled RETIC...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-07-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/8/2420 |
| _version_ | 1797561054712037376 |
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| author | Helmuth Tauber Nicole Innerhofer Daniel von Langen Mathias Ströhle Dietmar Fries Markus Mittermayr Tobias Hell Elgar Oswald Petra Innerhofer |
| author_facet | Helmuth Tauber Nicole Innerhofer Daniel von Langen Mathias Ströhle Dietmar Fries Markus Mittermayr Tobias Hell Elgar Oswald Petra Innerhofer |
| author_sort | Helmuth Tauber |
| collection | DOAJ |
| description | Although platelets play a central role in haemostasis, the dynamics of platelet counts during haemostatic resuscitation, the response to platelet transfusion, and effects on clinical outcome are poorly described for trauma patients. As a sub-study of the already published randomized controlled RETIC Study “Reversal of Trauma-induced Coagulopathy using First-line Coagulation Factor Concentrates or Fresh-Frozen Plasma” trial, we here analysed whether the type of first-line haemostatic resuscitation influences the frequency of platelet transfusion and determined the effects of platelet transfusion in coagulopathic patients with major trauma. Patients randomly received first-line plasma (FFP) or coagulation factor concentrates (CFC), mainly fibrinogen concentrate. In both groups, platelets were transfused to maintain platelet counts between 50 and 100 × 10<sup>9</sup>/L. Transfusion rates were significantly higher in the FFP (n = 44) vs. CFC (n = 50) group (FFP 47.7% vs. CFC 26%); <i>p</i> = 0.0335. Logistic regression analysis adjusted for the stratification variables injury severity score (ISS) and brain injury confirmed that first-line FFP therapy increases the odds for platelet transfusion (odds ratio (OR) 5.79 (1.89 to 20.62), <i>p</i> = 0.0036) and this effect was larger than a 16-point increase in ISS (OR 4.33 (2.17 to 9.74), <i>p</i> = 0.0001). In conclusion, early fibrinogen supplementation exerted a platelet-saving effect while platelet transfusions did not substantially improve platelet count and might contribute to poor clinical outcome. |
| first_indexed | 2024-03-10T18:08:55Z |
| format | Article |
| id | doaj.art-40437949b54e4f5e831c94ce49680279 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T18:08:55Z |
| publishDate | 2020-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-40437949b54e4f5e831c94ce496802792023-11-20T08:15:23ZengMDPI AGJournal of Clinical Medicine2077-03832020-07-0198242010.3390/jcm9082420Dynamics of Platelet Counts in Major Trauma: The Impact of Haemostatic Resuscitation and Effects of Platelet Transfusion—A Sub-Study of the Randomized Controlled RETIC TrialHelmuth Tauber0Nicole Innerhofer1Daniel von Langen2Mathias Ströhle3Dietmar Fries4Markus Mittermayr5Tobias Hell6Elgar Oswald7Petra Innerhofer8Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, AustriaDepartment of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, AustriaDepartment of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, AustriaDepartment of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, AustriaDepartment of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, AustriaDepartment of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, AustriaDepartment of Mathematics, Faculty of Mathematics, Computer Science and Physics, University of Innsbruck, 6020 Innsbruck, AustriaDepartment of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, AustriaDepartment of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, AustriaAlthough platelets play a central role in haemostasis, the dynamics of platelet counts during haemostatic resuscitation, the response to platelet transfusion, and effects on clinical outcome are poorly described for trauma patients. As a sub-study of the already published randomized controlled RETIC Study “Reversal of Trauma-induced Coagulopathy using First-line Coagulation Factor Concentrates or Fresh-Frozen Plasma” trial, we here analysed whether the type of first-line haemostatic resuscitation influences the frequency of platelet transfusion and determined the effects of platelet transfusion in coagulopathic patients with major trauma. Patients randomly received first-line plasma (FFP) or coagulation factor concentrates (CFC), mainly fibrinogen concentrate. In both groups, platelets were transfused to maintain platelet counts between 50 and 100 × 10<sup>9</sup>/L. Transfusion rates were significantly higher in the FFP (n = 44) vs. CFC (n = 50) group (FFP 47.7% vs. CFC 26%); <i>p</i> = 0.0335. Logistic regression analysis adjusted for the stratification variables injury severity score (ISS) and brain injury confirmed that first-line FFP therapy increases the odds for platelet transfusion (odds ratio (OR) 5.79 (1.89 to 20.62), <i>p</i> = 0.0036) and this effect was larger than a 16-point increase in ISS (OR 4.33 (2.17 to 9.74), <i>p</i> = 0.0001). In conclusion, early fibrinogen supplementation exerted a platelet-saving effect while platelet transfusions did not substantially improve platelet count and might contribute to poor clinical outcome.https://www.mdpi.com/2077-0383/9/8/2420blood coagulation disordersfibrinogen concentrateplasmaplatelet transfusionthrombelastography |
| spellingShingle | Helmuth Tauber Nicole Innerhofer Daniel von Langen Mathias Ströhle Dietmar Fries Markus Mittermayr Tobias Hell Elgar Oswald Petra Innerhofer Dynamics of Platelet Counts in Major Trauma: The Impact of Haemostatic Resuscitation and Effects of Platelet Transfusion—A Sub-Study of the Randomized Controlled RETIC Trial Journal of Clinical Medicine blood coagulation disorders fibrinogen concentrate plasma platelet transfusion thrombelastography |
| title | Dynamics of Platelet Counts in Major Trauma: The Impact of Haemostatic Resuscitation and Effects of Platelet Transfusion—A Sub-Study of the Randomized Controlled RETIC Trial |
| title_full | Dynamics of Platelet Counts in Major Trauma: The Impact of Haemostatic Resuscitation and Effects of Platelet Transfusion—A Sub-Study of the Randomized Controlled RETIC Trial |
| title_fullStr | Dynamics of Platelet Counts in Major Trauma: The Impact of Haemostatic Resuscitation and Effects of Platelet Transfusion—A Sub-Study of the Randomized Controlled RETIC Trial |
| title_full_unstemmed | Dynamics of Platelet Counts in Major Trauma: The Impact of Haemostatic Resuscitation and Effects of Platelet Transfusion—A Sub-Study of the Randomized Controlled RETIC Trial |
| title_short | Dynamics of Platelet Counts in Major Trauma: The Impact of Haemostatic Resuscitation and Effects of Platelet Transfusion—A Sub-Study of the Randomized Controlled RETIC Trial |
| title_sort | dynamics of platelet counts in major trauma the impact of haemostatic resuscitation and effects of platelet transfusion a sub study of the randomized controlled retic trial |
| topic | blood coagulation disorders fibrinogen concentrate plasma platelet transfusion thrombelastography |
| url | https://www.mdpi.com/2077-0383/9/8/2420 |
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