Assessment of three point-of-care platelet function assays in adult trauma patients

Connelly, Christopher R.; Yonge, John D.; McCully, Sean P.; Hart, Kyle D.; Hilliard, Thomas; Lape, Diane; Watson, Justin J.; Rick, Beth; Houser, Ben; DeLoughery, Thomas G.; Schreiber, Martin A.; Király, László

doi:10.1016/j.jss.2017.01.008

Cited by 53 publications

(59 citation statements)

References 32 publications

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“…Detection of antiplatelet agents in adult trauma patients was explored by Connelly and associates [26]. Out of the 64 patients enrolled, 25 were taking antiplatelet agents (mainly aspirin).…”

Section: Modified Vet: Teg Platelet Mappingmentioning

confidence: 99%

Sensitivity of Viscoelastic Tests to Platelet Function

Ranucci

Baryshnikova

2020

JCM

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Viscoelastic tests provide a dynamic assessment of coagulation, by exploring the time to clot formation and the clot strength. Using specific activators or inhibitors, additional factors can be explored, like the fibrinogen contribution to clot strength. Since the early days, various attempts have been done to measure platelet function with viscoelastic test. In general, the difference between the maximum clot strength and the fibrinogen contribution is considered an index of platelet contribution. However, this parameter does not clearly split platelet count from function; additionally, the extensive thrombin generation of standard activated viscoelastic tests activates platelet through the protease activated receptors, bypassing the other pathways. For this reason, standard viscoelastic tests cannot be used to assess platelet reactivity under the effects of aspirin or P2Y12 inhibitors. To overcome this limitation, a specific test was developed (thromboelastography platelet mapping). This test has been compared with the gold standard of light transmission aggregometry and with other point-of-care tests, with conflicting results. In general, the use of viscoelastic tests to assess the effects of antiplatelet agents is still limited. Conversely, platelet contribution to clot strength in the setting of coagulopathic bleeding is considered an important parameter to trigger platelet transfusion or desmopressin.

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Section: Modified Vet: Teg Platelet Mappingmentioning

confidence: 99%

Sensitivity of Viscoelastic Tests to Platelet Function

Ranucci

Baryshnikova

2020

JCM

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“…However, the ability of various assays to detect preinjury aspirin use or predict clinical outcomes has remained controversial. (6,28,29) There were several limitations of the study. First, information on patient compliance with the medication was not accessible in the database.…”

Section: Effect Of Preinjury Aspirin On Blunt Hepatic Injurymentioning

confidence: 99%

Aspirin Does Not Increase the Need for Hemostatic Interventions in Blunt Liver and Spleen Injuries.

Huang

Cheng

Fu³

et al. 2020

Preprint

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Background: The prohemorrhagic effect of aspirin may cause concern about worse prognoses when treating blunt hepatic or splenic injuries. This study investigated whether preinjury aspirin yields an increasing need for hemostatic interventions.Methods: Admission and outpatient records were extracted from the Taiwan National Health Insurance Research Database (NHIRD) from 2003 to 2015. Patients with splenic or hepatic injuries were identified. Patients with preinjury nonaspirin APAC or with penetrating injuries were excluded. The primary outcome measurement was the necessity of invasive procedures to stop bleeding, including transarterial embolization (TAE) and surgeries. One-to-two propensity score matching (PSM) was used to minimize selection bias. Multilogistic regression (MLR) analysis was used to identify factors associated with hemostatic interventions.Results: 20,470 (60.6%) had blunt hepatic injuries, and 15,235 (45.1%) had blunt splenic injuries, of whom 691 (3.4%) and 667 (4.4%) used preinjury aspirin, respectively. In the blunt hepatic injury cohort, there was no significant difference in the need for hemostatic procedures (TAE (6.1% vs 6.1%, p=1.000), exploratory laparotomy (6.1% vs 6.1%, p=1.000), hepatectomy (3.0% vs 2.7%, p=0.694) or hepatorrhaphy (14.3% vs 15.0%, p=0.681)). MLR analysis showed that preinjury aspirin did not increase the need for hemostatic interventions (OR 0.92, 95% CI 0.73-1.16, p=0.473). Regarding the blunt splenic injury cohort, there was no significant difference in the need for hemostatic procedures (TAE (11.5% vs 10.6%, p=0.547), splenectomy (43.5% vs 41.4%, p=0.407) or splenorrhaphy (3.0% vs 3.3%, p=0.698)). An MLR analysis showed that preinjury aspirin did not increase the need for hemostatic interventions (OR 1.12, 95% CI 0.91-1.38, p=0.290).Conclusions: Preinjury aspirin use is not associated with increased hemostatic procedures in blunt hepatic or splenic injuries.

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“…Although the PlateletMapping test can be used for the assessment of platelet reactivity in response to medication, such as in the recent CREA-TIVE trial, 3 a lot, if not most, of its use is in surgeries with high bleeding risk, such as cardiovascular and trauma surgery. [4][5][6][7][8][9] This is important to note because the clinical reality of this test is much more heterogeneous than that of other tests that are targeted specifically at the platelet effects of certain drugs (mostly P2Y12 inhibitors). Some of the other tests described in this article present with more than 40 000 data points and more than a decade of experience.…”

Section: ''mentioning

confidence: 99%