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

Christopher Robert Connelly, John D. Yonge, Sean P. McCully, Kyle D. Hart, Thomas C. Hilliard, Diane E. Lape, Justin J. Watson, Beth Rick, Ben Houser, Thomas Deloughery, Martin Schreiber, Laszlo N. Kiraly

    Research output: Contribution to journalArticle

    5 Citations (Scopus)

    Abstract

    Background Antiplatelet (AP) medication use is common among trauma patients and is associated with poor outcomes. Management options for platelet dysfunction in trauma patients are controversial, expensive, and potentially harmful. Although light transmission platelet aggregometry is considered the standard test to assess platelet function, it is cumbersome and not generally available. Currently, there are no widely accepted platelet function point-of-care tests for acute trauma. Study design Prospective observational study from 2014 to 2015. Baseline Multiplate aggregometry aspirin area under the platelet aggregation curve (ASPI AUC), Thrombelastography Platelet Mapping percent inhibition of arachidonic acid (TEG-PM AA), and VerifyNow Aspirin Test (ARU) were compared for ability to detect any AP medication use (aspirin or clopidogrel), platelet dysfunction, and identify patients at risk for intracranial hemorrhage (ICH) progression by calculating the area under receiver operating characteristic curves (AUC), sensitivity, specificity, and positive and negative predictive values. Adenosine diphosphate assays were similarly evaluated. Results Sixty-four patients were enrolled, 25 were taking AP medications. AP patients were older (71.6 versus 35.0 y, P < 0.001) and received more platelet transfusions, but other baseline characteristics were similar. Median ASPI AUC (22.0 versus 53.5 P < 0.001) and VerifyNow ARU (503.5 versus 629.0, P < 0.001) were lower, whereas TEG-PM AA (51.8% versus 18.3%, P < 0.001) was higher in AP patients. Multiplate ASPI AUC, TEG-PM AA percent inhibition, and VerifyNow ARU could identify AP medication use (AUC: 0.90, 0.77, and 0.90, respectively). Adenosine diphosphate assays did not correlate with AP medication use in this population. TEG-PM AA percent inhibition and VerifyNow ARU correlated well with Multiplate ASPI AUC to identify platelet dysfunction (AUC: 0.78, 0.89, respectively). ICH occurred in 29 patients; 12 of which had progression of their injury. ASPI AUC (AUC: 0.50) and VerifyNow ARU (AUC: 0.59) did not correlate, and TEG-PM AA percent inhibition (AUC: 0.66) minimally correlated with progression. Conclusions Multiplate, TEG-PM, and VerifyNow are useful point-of-care tests which identify AP medication use and platelet dysfunction in trauma patients. Initial TEG-PM AA percent inhibition may be associated with risk for ICH progression. However, additional large, prospective studies are needed.

    Original languageEnglish (US)
    Pages (from-to)260-269
    Number of pages10
    JournalJournal of Surgical Research
    Volume212
    DOIs
    StatePublished - May 15 2017

    Fingerprint

    Point-of-Care Systems
    Blood Platelets
    Thrombelastography
    Wounds and Injuries
    Aspirin
    Arachidonic Acid
    Area Under Curve
    Platelet Aggregation
    Intracranial Hemorrhages
    clopidogrel
    Adenosine Diphosphate
    Prospective Studies
    Platelet Transfusion

    Keywords

    • Multiplate
    • Platelet dysfunction trauma
    • Platelet function test trauma
    • Thrombelastogram platelet mapping
    • VerifyNow

    ASJC Scopus subject areas

    • Surgery

    Cite this

    Connelly, C. R., Yonge, J. D., McCully, S. P., Hart, K. D., Hilliard, T. C., Lape, D. E., ... Kiraly, L. N. (2017). Assessment of three point-of-care platelet function assays in adult trauma patients. Journal of Surgical Research, 212, 260-269. https://doi.org/10.1016/j.jss.2017.01.008

    Assessment of three point-of-care platelet function assays in adult trauma patients. / Connelly, Christopher Robert; Yonge, John D.; McCully, Sean P.; Hart, Kyle D.; Hilliard, Thomas C.; Lape, Diane E.; Watson, Justin J.; Rick, Beth; Houser, Ben; Deloughery, Thomas; Schreiber, Martin; Kiraly, Laszlo N.

    In: Journal of Surgical Research, Vol. 212, 15.05.2017, p. 260-269.

    Research output: Contribution to journalArticle

    Connelly, CR, Yonge, JD, McCully, SP, Hart, KD, Hilliard, TC, Lape, DE, Watson, JJ, Rick, B, Houser, B, Deloughery, T, Schreiber, M & Kiraly, LN 2017, 'Assessment of three point-of-care platelet function assays in adult trauma patients', Journal of Surgical Research, vol. 212, pp. 260-269. https://doi.org/10.1016/j.jss.2017.01.008
    Connelly, Christopher Robert ; Yonge, John D. ; McCully, Sean P. ; Hart, Kyle D. ; Hilliard, Thomas C. ; Lape, Diane E. ; Watson, Justin J. ; Rick, Beth ; Houser, Ben ; Deloughery, Thomas ; Schreiber, Martin ; Kiraly, Laszlo N. / Assessment of three point-of-care platelet function assays in adult trauma patients. In: Journal of Surgical Research. 2017 ; Vol. 212. pp. 260-269.
    @article{f0fe4608bb2e420697b16e6dd45dfd5f,
    title = "Assessment of three point-of-care platelet function assays in adult trauma patients",
    abstract = "Background Antiplatelet (AP) medication use is common among trauma patients and is associated with poor outcomes. Management options for platelet dysfunction in trauma patients are controversial, expensive, and potentially harmful. Although light transmission platelet aggregometry is considered the standard test to assess platelet function, it is cumbersome and not generally available. Currently, there are no widely accepted platelet function point-of-care tests for acute trauma. Study design Prospective observational study from 2014 to 2015. Baseline Multiplate aggregometry aspirin area under the platelet aggregation curve (ASPI AUC), Thrombelastography Platelet Mapping percent inhibition of arachidonic acid (TEG-PM AA), and VerifyNow Aspirin Test (ARU) were compared for ability to detect any AP medication use (aspirin or clopidogrel), platelet dysfunction, and identify patients at risk for intracranial hemorrhage (ICH) progression by calculating the area under receiver operating characteristic curves (AUC), sensitivity, specificity, and positive and negative predictive values. Adenosine diphosphate assays were similarly evaluated. Results Sixty-four patients were enrolled, 25 were taking AP medications. AP patients were older (71.6 versus 35.0 y, P < 0.001) and received more platelet transfusions, but other baseline characteristics were similar. Median ASPI AUC (22.0 versus 53.5 P < 0.001) and VerifyNow ARU (503.5 versus 629.0, P < 0.001) were lower, whereas TEG-PM AA (51.8{\%} versus 18.3{\%}, P < 0.001) was higher in AP patients. Multiplate ASPI AUC, TEG-PM AA percent inhibition, and VerifyNow ARU could identify AP medication use (AUC: 0.90, 0.77, and 0.90, respectively). Adenosine diphosphate assays did not correlate with AP medication use in this population. TEG-PM AA percent inhibition and VerifyNow ARU correlated well with Multiplate ASPI AUC to identify platelet dysfunction (AUC: 0.78, 0.89, respectively). ICH occurred in 29 patients; 12 of which had progression of their injury. ASPI AUC (AUC: 0.50) and VerifyNow ARU (AUC: 0.59) did not correlate, and TEG-PM AA percent inhibition (AUC: 0.66) minimally correlated with progression. Conclusions Multiplate, TEG-PM, and VerifyNow are useful point-of-care tests which identify AP medication use and platelet dysfunction in trauma patients. Initial TEG-PM AA percent inhibition may be associated with risk for ICH progression. However, additional large, prospective studies are needed.",
    keywords = "Multiplate, Platelet dysfunction trauma, Platelet function test trauma, Thrombelastogram platelet mapping, VerifyNow",
    author = "Connelly, {Christopher Robert} and Yonge, {John D.} and McCully, {Sean P.} and Hart, {Kyle D.} and Hilliard, {Thomas C.} and Lape, {Diane E.} and Watson, {Justin J.} and Beth Rick and Ben Houser and Thomas Deloughery and Martin Schreiber and Kiraly, {Laszlo N.}",
    year = "2017",
    month = "5",
    day = "15",
    doi = "10.1016/j.jss.2017.01.008",
    language = "English (US)",
    volume = "212",
    pages = "260--269",
    journal = "Journal of Surgical Research",
    issn = "0022-4804",
    publisher = "Academic Press Inc.",

    }

    TY - JOUR

    T1 - Assessment of three point-of-care platelet function assays in adult trauma patients

    AU - Connelly, Christopher Robert

    AU - Yonge, John D.

    AU - McCully, Sean P.

    AU - Hart, Kyle D.

    AU - Hilliard, Thomas C.

    AU - Lape, Diane E.

    AU - Watson, Justin J.

    AU - Rick, Beth

    AU - Houser, Ben

    AU - Deloughery, Thomas

    AU - Schreiber, Martin

    AU - Kiraly, Laszlo N.

    PY - 2017/5/15

    Y1 - 2017/5/15

    N2 - Background Antiplatelet (AP) medication use is common among trauma patients and is associated with poor outcomes. Management options for platelet dysfunction in trauma patients are controversial, expensive, and potentially harmful. Although light transmission platelet aggregometry is considered the standard test to assess platelet function, it is cumbersome and not generally available. Currently, there are no widely accepted platelet function point-of-care tests for acute trauma. Study design Prospective observational study from 2014 to 2015. Baseline Multiplate aggregometry aspirin area under the platelet aggregation curve (ASPI AUC), Thrombelastography Platelet Mapping percent inhibition of arachidonic acid (TEG-PM AA), and VerifyNow Aspirin Test (ARU) were compared for ability to detect any AP medication use (aspirin or clopidogrel), platelet dysfunction, and identify patients at risk for intracranial hemorrhage (ICH) progression by calculating the area under receiver operating characteristic curves (AUC), sensitivity, specificity, and positive and negative predictive values. Adenosine diphosphate assays were similarly evaluated. Results Sixty-four patients were enrolled, 25 were taking AP medications. AP patients were older (71.6 versus 35.0 y, P < 0.001) and received more platelet transfusions, but other baseline characteristics were similar. Median ASPI AUC (22.0 versus 53.5 P < 0.001) and VerifyNow ARU (503.5 versus 629.0, P < 0.001) were lower, whereas TEG-PM AA (51.8% versus 18.3%, P < 0.001) was higher in AP patients. Multiplate ASPI AUC, TEG-PM AA percent inhibition, and VerifyNow ARU could identify AP medication use (AUC: 0.90, 0.77, and 0.90, respectively). Adenosine diphosphate assays did not correlate with AP medication use in this population. TEG-PM AA percent inhibition and VerifyNow ARU correlated well with Multiplate ASPI AUC to identify platelet dysfunction (AUC: 0.78, 0.89, respectively). ICH occurred in 29 patients; 12 of which had progression of their injury. ASPI AUC (AUC: 0.50) and VerifyNow ARU (AUC: 0.59) did not correlate, and TEG-PM AA percent inhibition (AUC: 0.66) minimally correlated with progression. Conclusions Multiplate, TEG-PM, and VerifyNow are useful point-of-care tests which identify AP medication use and platelet dysfunction in trauma patients. Initial TEG-PM AA percent inhibition may be associated with risk for ICH progression. However, additional large, prospective studies are needed.

    AB - Background Antiplatelet (AP) medication use is common among trauma patients and is associated with poor outcomes. Management options for platelet dysfunction in trauma patients are controversial, expensive, and potentially harmful. Although light transmission platelet aggregometry is considered the standard test to assess platelet function, it is cumbersome and not generally available. Currently, there are no widely accepted platelet function point-of-care tests for acute trauma. Study design Prospective observational study from 2014 to 2015. Baseline Multiplate aggregometry aspirin area under the platelet aggregation curve (ASPI AUC), Thrombelastography Platelet Mapping percent inhibition of arachidonic acid (TEG-PM AA), and VerifyNow Aspirin Test (ARU) were compared for ability to detect any AP medication use (aspirin or clopidogrel), platelet dysfunction, and identify patients at risk for intracranial hemorrhage (ICH) progression by calculating the area under receiver operating characteristic curves (AUC), sensitivity, specificity, and positive and negative predictive values. Adenosine diphosphate assays were similarly evaluated. Results Sixty-four patients were enrolled, 25 were taking AP medications. AP patients were older (71.6 versus 35.0 y, P < 0.001) and received more platelet transfusions, but other baseline characteristics were similar. Median ASPI AUC (22.0 versus 53.5 P < 0.001) and VerifyNow ARU (503.5 versus 629.0, P < 0.001) were lower, whereas TEG-PM AA (51.8% versus 18.3%, P < 0.001) was higher in AP patients. Multiplate ASPI AUC, TEG-PM AA percent inhibition, and VerifyNow ARU could identify AP medication use (AUC: 0.90, 0.77, and 0.90, respectively). Adenosine diphosphate assays did not correlate with AP medication use in this population. TEG-PM AA percent inhibition and VerifyNow ARU correlated well with Multiplate ASPI AUC to identify platelet dysfunction (AUC: 0.78, 0.89, respectively). ICH occurred in 29 patients; 12 of which had progression of their injury. ASPI AUC (AUC: 0.50) and VerifyNow ARU (AUC: 0.59) did not correlate, and TEG-PM AA percent inhibition (AUC: 0.66) minimally correlated with progression. Conclusions Multiplate, TEG-PM, and VerifyNow are useful point-of-care tests which identify AP medication use and platelet dysfunction in trauma patients. Initial TEG-PM AA percent inhibition may be associated with risk for ICH progression. However, additional large, prospective studies are needed.

    KW - Multiplate

    KW - Platelet dysfunction trauma

    KW - Platelet function test trauma

    KW - Thrombelastogram platelet mapping

    KW - VerifyNow

    UR - http://www.scopus.com/inward/record.url?scp=85015685273&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=85015685273&partnerID=8YFLogxK

    U2 - 10.1016/j.jss.2017.01.008

    DO - 10.1016/j.jss.2017.01.008

    M3 - Article

    VL - 212

    SP - 260

    EP - 269

    JO - Journal of Surgical Research

    JF - Journal of Surgical Research

    SN - 0022-4804

    ER -