Early high ratio platelet transfusion in trauma resuscitation and its outcomes

Abstract

Introduction:The optimal ratio of platelets (PLTs) to packed red blood cell (PRBC) in trauma patients requiring massive transfusion protocol (MTP) is still controversial. This report aims to describe the effect of attaining a high PLT:PRBC ratio (≥1:1.5) within 4 h postinjury on the outcomes of trauma patients receiving MTP.Methods:Over a 24-month period, records of all adult patients with traumatic injury who received MTP were retrospectively reviewed. Data were analyzed with respect to PLT:PRBC ratio ([high-MTP ≥1:1.5] [HMTP] vs. [low-MTP <1:1.5] [LMTP]) given within the first 4 h postinjury and also between (>4 and 24 h). Baseline demographic, clinical characteristics, complications, and outcomes were compared according to HMTP and LMTP.Results:Of the total 3244 trauma patients, PLT:PRBC ratio was attainable in 58 (1.2%) patients who fulfilled the inclusion criteria. The mean age was 32.3 ± 10.7 years; the majority were males (89.6%) with high mean Injury Severity Score (ISS): 31.9 ± 11.5 and Revise Trauma Score (RTS): 5.1 ± 2.2. There was no significant association between age, gender, type of injury, presenting hemoglobin, International Normalized Ratio, ISS, and RTS. The rate of ventilator–associated pneumonia (38.9% vs. 10.8%; P = 0.02) and wound infection (50% vs. 10.8%; P = 0.002) were significantly higher in the HMTP group. However, HMTP was associated with lower rate of multiple organ failure (MOF) (42.1% vs. 87.2%, P = 0.001) and mortality (36.8% vs. 84.6%, P = 0.001) within the first 30 days postinjury.Conclusions:Our study revealed that early attainment of high PLT/PRBC ratio within 4 h postinjury is significantly associated with lower MOF and mortality in trauma patients.

Abdominal Travmada Mortaliteyi Etkileyen Risk Faktörlerinin Analizi

“…Consumption coagulopathy and platelet dysfunction are prominent features of severe hemorrhagic shock. [20] In the present study, we found lower mean platelet counts and increased INR in abdominal trauma patients with mortality when compared to patients without mortality. This is a reflection of the degree of blood loss that resulted in platelet dysfunction and coagulopathy due to consumption.…”

The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition

“…Significant protective association between higher platelet ratios and mortality was concentrated during the first 6 h only, in contrast to high plasma ratios, which were protective throughout the first 24 h [576]. A recent observational study confirms that a high platelet:RBC ratio (≥ 1:1.5) within 4 h post-injury but not later (4–24 h) is significantly associated with a lower rate of multiple organ failure and mortality within 30 days post-injury, although with higher rates of wound infection and pneumonia [686].…”

Contractile forces in platelet aggregates under microfluidic shear gradients reflect platelet inhibition and bleeding risk

“…Evidence also suggests that platelet aggregation, and more so platelet contributions to clot stiffness, can become impaired almost immediately after severe trauma, suggesting that intrinsic platelet dysfunction also plays an important role in the development of TIC 42 – 44 . Platelet function, when measured at Emergency Department arrival, is also strongly associated with mortality and blood transfusion requirements 42 , 45 , and high ratios of platelet to packed red blood cell transfusions during trauma resuscitation are associated with decreased mortality 46 . Clinical measurement of platelet function has been typically measured by platelet count, which, when decreased, is related to mortality after trauma 47 .…”