Impact of platelet transfusion on outcomes in trauma patients

Abstract

Background Trauma-induced coagulopathy includes thrombocytopenia and platelet dysfunction that impact patient outcome. Nevertheless, the role of platelet transfusion remains poorly defined. The aim of the study was 1/ to evaluate the impact of early platelet transfusion on 24-h all-cause mortality and 2/ to describe platelet count at admission (PCA) and its relationship with trauma severity and outcome. Methods Observational study carried out on a multicentre prospective trauma registry. All adult trauma patients directly admitted in participating trauma centres between May 2011 and June 2019 were included. Severe haemorrhage was defined as ≥ 4 red blood cell units within 6 h and/or death from exsanguination. The impact of PCA and early platelet transfusion (i.e. within the first 6 h) on 24-h all-cause mortality was assessed using uni- and multivariate logistic regression. Results Among the 19,596 included patients, PCA (229 G/L [189,271]) was associated with coagulopathy, traumatic burden, shock and bleeding severity. In a logistic regression model, 24-h all-cause mortality increased by 37% for every 50 G/L decrease in platelet count (OR 0.63 95% CI 0.57–0.70; p < 0.001). Regarding patients with severe hemorrhage, platelets were transfused early for 36% of patients. Early platelet transfusion was associated with a decrease in 24-h all-cause mortality (versus no or late platelets): OR 0.52 (95% CI 0.34–0.79; p < 0.05). Conclusions PCA, although mainly in normal range, was associated with trauma severity and coagulopathy and was predictive of bleeding intensity and outcome. Early platelet transfusion within 6 h was associated with a decrease in mortality in patients with severe hemorrhage. Future studies are needed to determine which doses of platelet transfusion will improve outcomes after major trauma.

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

“…In patients with MT, early platelet transfusion within 4 h was associated with lower rate of multiorgan failure and mortality within 30 days post-injury, although with a higher rate of ventilator-associated pneumonia and wound infections [ 261 ]. Similarly, in a large trauma database early platelet transfusion within 6 h was associated with decreased 24 h mortality both in patients with massive and non-massive transfusion [ 262 ].…”

“…While a low platelet count has been consistently associated with both morbidity and mortality in trauma patients, the threshold and timing of platelet transfusion remains controversial [ 6 ]. Although the platelet count at admission was found to be a biomarker for trauma severity and predictive of outcome, including bleeding intensity and transfusion requirements [ 262 ], platelet counts are frequently within the normal range at hospital admission, but may decrease sharply in the following 1–2 h of haemostatic resuscitation and decline continuously thereafter, suggesting an important role for the treatment administered [ 310 ].…”

Multiplate Platelet Function Testing upon Emergency Room Admission Fails to Provide Useful Information in Major Trauma Patients Not on Platelet Inhibitors

“…Between June 2012 and July 2021, a total of 328 predominantly male (75.3%) subjects fulfilled the inclusion criteria (Figure 1). The mean age was 53 (37-68 IQR) years, the median ISS was 29 (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). According to the predefined criteria, there were 72 patients in the isolated traumatic brain injury group (TBI group), 141 patients in the group of major trauma without TBI (MT group), and 115 patients in the group of major trauma with additional TBI (MT + TBI group).…”

“…A low platelet count in severely injured patients is associated with poor outcome in both isolated TBI and polytrauma [28,29]. However, the platelet count does not provide any meaningful information about the platelet function.…”

Platelet Transfusion for Trauma Resuscitation

“…These hemostatic strategies of resuscitation with balanced ratios of RBC:plasma and RBC:platelets lead to earlier correction of coagulopathies and lower hemorrhagerelated mortality in injured patients requiring large volume transfusion [33][34][35][36][37][38]. Both the timing and ratios of blood products are important, as early platelet transfusion within the first 6 h after injury has been shown to be most beneficial to hemostasis and mortality, both in combat and civilian populations [39][40][41][42][43][44][45]. A recent study of the American College of Surgeons Trauma Quality Improvement Program (TQIP) database demonstrated that unbalanced platelet:RBC transfusion ratios are common with nearly twice as many patients receiving unbalanced ratios, which portended worse odds of mortality than unbalanced plasma:RBC transfusion ratios.…”