A prospective study of platelet function in trauma patients

Matthew T. Ramsey, Timothy Fabian, Charles P. Shahan, John P. Sharpe, Scott E. Mabry, Jordan A. Weinberg, Martin Croce, Lisa K. Jennings

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

BACKGROUND: Exsanguination associated with acute traumatic coagulopathy is a leading cause of death following injury. While platelets occupy a pivotal role in clot formation, clinical research has been scant because of complexities resulting from the need for rapid handling and complex testing of platelet functions. While the thrombin pathway has been proposed as a mediator of platelet dysfunction in trauma, it has not been systematically investigated. The purpose of this study was to evaluate the thrombin pathway in platelet dysfunction. METHODS: Forty trauma patients and 20 noninjured controls were enrolled in the study at a Level I trauma center. Platelet aggregation was tested by light transmission aggregometry with two agonists, adenosine diphosphate (ADP) and thrombin receptor agonist peptide (TRAP).Mean fluorescence intensity and percent positivity of CD62 on ADP-activated plateletswere evaluated using flow cytometry. Enzyme-linked immunosorbent assays were performed to evaluate the concentrations of D-dimer, thrombin-antithrombin complex (TAT), and prothrombin fragment 1 + 2 (PF 1 + 2) in each sample. RESULTS: Compared with healthy controls, trauma patients had significantly decreased ADP- and TRAP-mediated platelet aggregation and ADP-mediated CD62 expression. In trauma patients, TRAP-mediated aggregation was inversely proportional to head Abbreviated Injury Scale (AIS) score. Glasgow Coma Scale (GCS) score was directly proportional to TRAP- and ADP-mediated aggregation. When compared with controls, significant differences of D-dimer, TAT, and PF 1 + 2 were found. Measures of shock, including admission blood pressure, pulse, base deficit, and lactate level, did not correlate with platelet dysfunction. CONCLUSION: Trauma patients have significantly lower levels of platelet activation and aggregation compared with healthy controls. Severity of head injury was significantly correlated with platelet dysfunction in a stepwise fashion. Trauma patients also have significantly increased levels of D-dimer, TAT, and PF 1 + 2 when compared with healthy controls. Our data suggest that the thrombin receptor pathway plays an important role in platelet dysfunction in trauma.

Original languageEnglish (US)
Pages (from-to)726-733
Number of pages8
JournalJournal of Trauma and Acute Care Surgery
Volume80
Issue number5
DOIs
StatePublished - Feb 18 2016

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Thrombin Receptors
Blood Platelets
Prospective Studies
Adenosine Diphosphate
Wounds and Injuries
Platelet Aggregation
Peptides
Purinergic P1 Receptors
Craniocerebral Trauma
Thrombin
Abbreviated Injury Scale
Exsanguination
Glasgow Coma Scale
Trauma Centers
Platelet Activation
Cause of Death
Shock
Lactic Acid
Flow Cytometry
Fluorescence

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Ramsey, M. T., Fabian, T., Shahan, C. P., Sharpe, J. P., Mabry, S. E., Weinberg, J. A., ... Jennings, L. K. (2016). A prospective study of platelet function in trauma patients. Journal of Trauma and Acute Care Surgery, 80(5), 726-733. https://doi.org/10.1097/TA.0000000000001017

A prospective study of platelet function in trauma patients. / Ramsey, Matthew T.; Fabian, Timothy; Shahan, Charles P.; Sharpe, John P.; Mabry, Scott E.; Weinberg, Jordan A.; Croce, Martin; Jennings, Lisa K.

In: Journal of Trauma and Acute Care Surgery, Vol. 80, No. 5, 18.02.2016, p. 726-733.

Research output: Contribution to journalArticle

Ramsey, MT, Fabian, T, Shahan, CP, Sharpe, JP, Mabry, SE, Weinberg, JA, Croce, M & Jennings, LK 2016, 'A prospective study of platelet function in trauma patients', Journal of Trauma and Acute Care Surgery, vol. 80, no. 5, pp. 726-733. https://doi.org/10.1097/TA.0000000000001017
Ramsey MT, Fabian T, Shahan CP, Sharpe JP, Mabry SE, Weinberg JA et al. A prospective study of platelet function in trauma patients. Journal of Trauma and Acute Care Surgery. 2016 Feb 18;80(5):726-733. https://doi.org/10.1097/TA.0000000000001017
Ramsey, Matthew T. ; Fabian, Timothy ; Shahan, Charles P. ; Sharpe, John P. ; Mabry, Scott E. ; Weinberg, Jordan A. ; Croce, Martin ; Jennings, Lisa K. / A prospective study of platelet function in trauma patients. In: Journal of Trauma and Acute Care Surgery. 2016 ; Vol. 80, No. 5. pp. 726-733.
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