Low level of procoagulant platelet microparticles is associated with impaired coagulation and transfusion requirements in trauma patients

Nis Agerlin Windeløv; Pär Ingemar Johansson; Anne Marie Sørensen; Anders Perner; Michael Wanscher; Claus Falck Larsen; Sisse Rye Ostrowski; Lars Simon Rasmussen

doi:10.1097/ta.0000000000000437

Low level of procoagulant platelet microparticles is associated with impaired coagulation and transfusion requirements in trauma patients

Nis Agerlin Windeløv, Pär Ingemar Johansson, Anne Marie Sørensen, Anders Perner, Michael Wanscher, Claus Falck Larsen, Sisse Rye Ostrowski, Lars Simon Rasmussen

Institut for Klinisk Medicin

20 Citationer (Scopus)

Abstract

Background: Following activation, platelets release small vesicles called platelet-derived microparticles (PMPs). PMPs accelerate thrombin generation and thus clot formation at sites of injury by exposing the procoagulant membrane phospholipid phosphatidylserine (PS). The role of PMPs in coagulopathy and hemorrhage following trauma remains elusive.We hypothesized that low levels of PS-positive PMPs (PS + PMPs) would be associated with impaired clot formation. Methods: This is a prospective observational study of 210 trauma patients admitted directly to a Level 1 trauma center. Plasma levels of PS + PMPs were determined by flow cytometry. Coagulation status was assessed by rotational thrombelastometry, and impaired clot formation was defined by an > angle less than 63 degrees using the tissue factorYbased EXTEM reagent. Transfusion requirement was assessed by number of units of red blood cells (RBCs) transfused within 24 hours of admission; platelet aggregation capacity was evaluated by the Multiplate assay; and injury severity was determined by the Injury Severity Score (ISS). RESULTS: The median ISS was 17, and blood samples were obtained after a median of 65 minutes following injury. Significantly lower levels of PS + PMPs were found in patients with impaired clot formation (p G 0.001). A low level of PS + PMPs was associated with a higher number of RBCs transfused during the initial 24 hours after admission (p G 0.03) when corrected for risk factors, for example, platelet count, hemoglobin level, and ISS. Platelet aggregation and PS + PMPs did not correlate significantly. Conclusion: Low levels of PMPs were associated with impaired clot formation in trauma patients at admission and also with the number of RBC transfusions. This suggests that PMPs may play an important and not previously investigated role in trauma-induced coagulopathy. Level of Evidence: Prognostic study, level III.

Originalsprog	Engelsk
Tidsskrift	The Journal of Trauma and Acute Care Surgery
Vol/bind	77
Udgave nummer	5
Sider (fra-til)	692-700
Antal sider	9
ISSN	0022-5282
DOI	https://doi.org/10.1097/ta.0000000000000437
Status	Udgivet - 1 nov. 2014

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10.1097/ta.0000000000000437

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Windeløv, N. A., Johansson, P. I., Sørensen, A. M., Perner, A., Wanscher, M., Larsen, C. F., Ostrowski, S. R., & Rasmussen, L. S. (2014). Low level of procoagulant platelet microparticles is associated with impaired coagulation and transfusion requirements in trauma patients. The Journal of Trauma and Acute Care Surgery, 77(5), 692-700. https://doi.org/10.1097/ta.0000000000000437

Low level of procoagulant platelet microparticles is associated with impaired coagulation and transfusion requirements in trauma patients. / Windeløv, Nis Agerlin; Johansson, Pär Ingemar; Sørensen, Anne Marie et al.

I: The Journal of Trauma and Acute Care Surgery, Bind 77, Nr. 5, 01.11.2014, s. 692-700.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Windeløv, NA, Johansson, PI, Sørensen, AM, Perner, A, Wanscher, M, Larsen, CF, Ostrowski, SR & Rasmussen, LS 2014, 'Low level of procoagulant platelet microparticles is associated with impaired coagulation and transfusion requirements in trauma patients', The Journal of Trauma and Acute Care Surgery, bind 77, nr. 5, s. 692-700. https://doi.org/10.1097/ta.0000000000000437

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title = "Low level of procoagulant platelet microparticles is associated with impaired coagulation and transfusion requirements in trauma patients",

abstract = "Background: Following activation, platelets release small vesicles called platelet-derived microparticles (PMPs). PMPs accelerate thrombin generation and thus clot formation at sites of injury by exposing the procoagulant membrane phospholipid phosphatidylserine (PS). The role of PMPs in coagulopathy and hemorrhage following trauma remains elusive.We hypothesized that low levels of PS-positive PMPs (PS + PMPs) would be associated with impaired clot formation. Methods: This is a prospective observational study of 210 trauma patients admitted directly to a Level 1 trauma center. Plasma levels of PS + PMPs were determined by flow cytometry. Coagulation status was assessed by rotational thrombelastometry, and impaired clot formation was defined by an > angle less than 63 degrees using the tissue factorYbased EXTEM reagent. Transfusion requirement was assessed by number of units of red blood cells (RBCs) transfused within 24 hours of admission; platelet aggregation capacity was evaluated by the Multiplate assay; and injury severity was determined by the Injury Severity Score (ISS). RESULTS: The median ISS was 17, and blood samples were obtained after a median of 65 minutes following injury. Significantly lower levels of PS + PMPs were found in patients with impaired clot formation (p G 0.001). A low level of PS + PMPs was associated with a higher number of RBCs transfused during the initial 24 hours after admission (p G 0.03) when corrected for risk factors, for example, platelet count, hemoglobin level, and ISS. Platelet aggregation and PS + PMPs did not correlate significantly. Conclusion: Low levels of PMPs were associated with impaired clot formation in trauma patients at admission and also with the number of RBC transfusions. This suggests that PMPs may play an important and not previously investigated role in trauma-induced coagulopathy. Level of Evidence: Prognostic study, level III.",

author = "Windel{\o}v, {Nis Agerlin} and Johansson, {P{\"a}r Ingemar} and S{\o}rensen, {Anne Marie} and Anders Perner and Michael Wanscher and Larsen, {Claus Falck} and Ostrowski, {Sisse Rye} and Rasmussen, {Lars Simon}",

year = "2014",

month = nov,

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doi = "10.1097/ta.0000000000000437",

language = "English",

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journal = "Journal of Trauma",

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TY - JOUR

T1 - Low level of procoagulant platelet microparticles is associated with impaired coagulation and transfusion requirements in trauma patients

AU - Windeløv, Nis Agerlin

AU - Johansson, Pär Ingemar

AU - Sørensen, Anne Marie

AU - Perner, Anders

AU - Wanscher, Michael

AU - Larsen, Claus Falck

AU - Ostrowski, Sisse Rye

AU - Rasmussen, Lars Simon

PY - 2014/11/1

Y1 - 2014/11/1

N2 - Background: Following activation, platelets release small vesicles called platelet-derived microparticles (PMPs). PMPs accelerate thrombin generation and thus clot formation at sites of injury by exposing the procoagulant membrane phospholipid phosphatidylserine (PS). The role of PMPs in coagulopathy and hemorrhage following trauma remains elusive.We hypothesized that low levels of PS-positive PMPs (PS + PMPs) would be associated with impaired clot formation. Methods: This is a prospective observational study of 210 trauma patients admitted directly to a Level 1 trauma center. Plasma levels of PS + PMPs were determined by flow cytometry. Coagulation status was assessed by rotational thrombelastometry, and impaired clot formation was defined by an > angle less than 63 degrees using the tissue factorYbased EXTEM reagent. Transfusion requirement was assessed by number of units of red blood cells (RBCs) transfused within 24 hours of admission; platelet aggregation capacity was evaluated by the Multiplate assay; and injury severity was determined by the Injury Severity Score (ISS). RESULTS: The median ISS was 17, and blood samples were obtained after a median of 65 minutes following injury. Significantly lower levels of PS + PMPs were found in patients with impaired clot formation (p G 0.001). A low level of PS + PMPs was associated with a higher number of RBCs transfused during the initial 24 hours after admission (p G 0.03) when corrected for risk factors, for example, platelet count, hemoglobin level, and ISS. Platelet aggregation and PS + PMPs did not correlate significantly. Conclusion: Low levels of PMPs were associated with impaired clot formation in trauma patients at admission and also with the number of RBC transfusions. This suggests that PMPs may play an important and not previously investigated role in trauma-induced coagulopathy. Level of Evidence: Prognostic study, level III.

AB - Background: Following activation, platelets release small vesicles called platelet-derived microparticles (PMPs). PMPs accelerate thrombin generation and thus clot formation at sites of injury by exposing the procoagulant membrane phospholipid phosphatidylserine (PS). The role of PMPs in coagulopathy and hemorrhage following trauma remains elusive.We hypothesized that low levels of PS-positive PMPs (PS + PMPs) would be associated with impaired clot formation. Methods: This is a prospective observational study of 210 trauma patients admitted directly to a Level 1 trauma center. Plasma levels of PS + PMPs were determined by flow cytometry. Coagulation status was assessed by rotational thrombelastometry, and impaired clot formation was defined by an > angle less than 63 degrees using the tissue factorYbased EXTEM reagent. Transfusion requirement was assessed by number of units of red blood cells (RBCs) transfused within 24 hours of admission; platelet aggregation capacity was evaluated by the Multiplate assay; and injury severity was determined by the Injury Severity Score (ISS). RESULTS: The median ISS was 17, and blood samples were obtained after a median of 65 minutes following injury. Significantly lower levels of PS + PMPs were found in patients with impaired clot formation (p G 0.001). A low level of PS + PMPs was associated with a higher number of RBCs transfused during the initial 24 hours after admission (p G 0.03) when corrected for risk factors, for example, platelet count, hemoglobin level, and ISS. Platelet aggregation and PS + PMPs did not correlate significantly. Conclusion: Low levels of PMPs were associated with impaired clot formation in trauma patients at admission and also with the number of RBC transfusions. This suggests that PMPs may play an important and not previously investigated role in trauma-induced coagulopathy. Level of Evidence: Prognostic study, level III.

U2 - 10.1097/ta.0000000000000437

DO - 10.1097/ta.0000000000000437

M3 - Journal article

C2 - 25494419

SN - 2163-0755

VL - 77

SP - 692

EP - 700

JO - Journal of Trauma

JF - Journal of Trauma

IS - 5

ER -

Low level of procoagulant platelet microparticles is associated with impaired coagulation and transfusion requirements in trauma patients

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