Thromboelastography Does Not Detect Preinjury Antiplatelet Therapy in Acute Trauma Patients
Thromboelastography (TEG) with platelet mapping has been proposed as an assay to detect the presence of antiplatelet agents (APA), yet no study has evaluated TEG markers of platelet dysfunction in acute trauma patients stratified by the use of preinjury APA. We hypothesized that patients on preinjur...
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| Veröffentlicht in: | The American surgeon 2016-02, Vol.82 (2), p.175-180 |
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| creator | Daley, Mitchell J. Trust, Marc D. Peterson, Evan J. Luftman, Kevin Miller, Andrew H. Ali, Sadia Clark, Adam Aydelotte, Jayson D. Coopwood, Thomas B. Brown, Carlos V.R. |
| description | Thromboelastography (TEG) with platelet mapping has been proposed as an assay to detect the presence of antiplatelet agents (APA), yet no study has evaluated TEG markers of platelet dysfunction in acute trauma patients stratified by the use of preinjury APA. We hypothesized that patients on preinjury APA would demonstrate prolonged TEG markers of platelet dysfunction compared with those not on preinjury APA. This retrospective review evaluated all trauma patients admitted to a Level I trauma center from February 2011 to April 2013 who received a TEG within the first 24 hours of admission. Patients were classified as receiving preinjury APA or no APA if their documented medications included either aspirin or adenosine diphosphate (ADP) antagonists, including clopidogrel, prasugrel, and ticagrelor. A total of 129 patients were included (APA, n = 35; no APA n = 94) in the study. The time from admission to the first TEG was similar (APA 175 ± 289 minutes versus no APA 216 ± 321 minutes, P = 0.5). There was no significant difference in TEG markers of platelet dysfunction, including per cent ADP inhibition (APA 61.7 ± 25.8% versus no APA 62.3 ± 28.8%; P = 0.91) or per cent arachidonic acid inhibition (APA 58.2 ± 31% versus no APA 53.8 ± 34%; P = 0.54). Both groups had similar proportion of severe platelet dysfunction, defined as ADP inhibition greater than 70 per cent (APA 40% versus no APA 40%; P = 0.8) and arachidonic acid inhibition greater than 70 per cent (APA 40% versus no APA 39%; P = 0.89). In conclusion, platelet dysfunction after major trauma is common. Therefore, TEG alone should not be used to evaluate for the presence of APA due to apparent lack of specificity. |
| doi_str_mv | 10.1177/000313481608200224 |
| format | Article |
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We hypothesized that patients on preinjury APA would demonstrate prolonged TEG markers of platelet dysfunction compared with those not on preinjury APA. This retrospective review evaluated all trauma patients admitted to a Level I trauma center from February 2011 to April 2013 who received a TEG within the first 24 hours of admission. Patients were classified as receiving preinjury APA or no APA if their documented medications included either aspirin or adenosine diphosphate (ADP) antagonists, including clopidogrel, prasugrel, and ticagrelor. A total of 129 patients were included (APA, n = 35; no APA n = 94) in the study. The time from admission to the first TEG was similar (APA 175 ± 289 minutes versus no APA 216 ± 321 minutes, P = 0.5). There was no significant difference in TEG markers of platelet dysfunction, including per cent ADP inhibition (APA 61.7 ± 25.8% versus no APA 62.3 ± 28.8%; P = 0.91) or per cent arachidonic acid inhibition (APA 58.2 ± 31% versus no APA 53.8 ± 34%; P = 0.54). Both groups had similar proportion of severe platelet dysfunction, defined as ADP inhibition greater than 70 per cent (APA 40% versus no APA 40%; P = 0.8) and arachidonic acid inhibition greater than 70 per cent (APA 40% versus no APA 39%; P = 0.89). In conclusion, platelet dysfunction after major trauma is common. Therefore, TEG alone should not be used to evaluate for the presence of APA due to apparent lack of specificity.</description><identifier>ISSN: 0003-1348</identifier><identifier>EISSN: 1555-9823</identifier><identifier>DOI: 10.1177/000313481608200224</identifier><identifier>PMID: 26874143</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Abdomen ; Acute coronary syndromes ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Blood platelets ; Blood Platelets - drug effects ; Blood Platelets - physiology ; Bone surgery ; Clinical outcomes ; Clinical trials ; Female ; Humans ; Male ; Middle Aged ; Mortality ; Platelet Aggregation Inhibitors - adverse effects ; Retrospective Studies ; Sensitivity and Specificity ; Studies ; Thrombelastography ; Trauma ; Variables ; Ventilation ; Wounds and Injuries - blood ; Wounds and Injuries - physiopathology ; Young Adult</subject><ispartof>The American surgeon, 2016-02, Vol.82 (2), p.175-180</ispartof><rights>2016 Southeastern Surgical Congress</rights><rights>Copyright Southeastern Surgical Congress Feb 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c415t-4bf6205c87344502516362b55637c6d1ff946983705b3dcde4a38699967b319c3</citedby><cites>FETCH-LOGICAL-c415t-4bf6205c87344502516362b55637c6d1ff946983705b3dcde4a38699967b319c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/000313481608200224$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/000313481608200224$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,777,781,21800,27905,27906,43602,43603</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26874143$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Daley, Mitchell J.</creatorcontrib><creatorcontrib>Trust, Marc D.</creatorcontrib><creatorcontrib>Peterson, Evan J.</creatorcontrib><creatorcontrib>Luftman, Kevin</creatorcontrib><creatorcontrib>Miller, Andrew H.</creatorcontrib><creatorcontrib>Ali, Sadia</creatorcontrib><creatorcontrib>Clark, Adam</creatorcontrib><creatorcontrib>Aydelotte, Jayson D.</creatorcontrib><creatorcontrib>Coopwood, Thomas B.</creatorcontrib><creatorcontrib>Brown, Carlos V.R.</creatorcontrib><title>Thromboelastography Does Not Detect Preinjury Antiplatelet Therapy in Acute Trauma Patients</title><title>The American surgeon</title><addtitle>Am Surg</addtitle><description>Thromboelastography (TEG) with platelet mapping has been proposed as an assay to detect the presence of antiplatelet agents (APA), yet no study has evaluated TEG markers of platelet dysfunction in acute trauma patients stratified by the use of preinjury APA. We hypothesized that patients on preinjury APA would demonstrate prolonged TEG markers of platelet dysfunction compared with those not on preinjury APA. This retrospective review evaluated all trauma patients admitted to a Level I trauma center from February 2011 to April 2013 who received a TEG within the first 24 hours of admission. Patients were classified as receiving preinjury APA or no APA if their documented medications included either aspirin or adenosine diphosphate (ADP) antagonists, including clopidogrel, prasugrel, and ticagrelor. A total of 129 patients were included (APA, n = 35; no APA n = 94) in the study. The time from admission to the first TEG was similar (APA 175 ± 289 minutes versus no APA 216 ± 321 minutes, P = 0.5). There was no significant difference in TEG markers of platelet dysfunction, including per cent ADP inhibition (APA 61.7 ± 25.8% versus no APA 62.3 ± 28.8%; P = 0.91) or per cent arachidonic acid inhibition (APA 58.2 ± 31% versus no APA 53.8 ± 34%; P = 0.54). Both groups had similar proportion of severe platelet dysfunction, defined as ADP inhibition greater than 70 per cent (APA 40% versus no APA 40%; P = 0.8) and arachidonic acid inhibition greater than 70 per cent (APA 40% versus no APA 39%; P = 0.89). In conclusion, platelet dysfunction after major trauma is common. Therefore, TEG alone should not be used to evaluate for the presence of APA due to apparent lack of specificity.</description><subject>Abdomen</subject><subject>Acute coronary syndromes</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Blood platelets</subject><subject>Blood Platelets - drug effects</subject><subject>Blood Platelets - physiology</subject><subject>Bone surgery</subject><subject>Clinical outcomes</subject><subject>Clinical trials</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Platelet Aggregation Inhibitors - adverse effects</subject><subject>Retrospective Studies</subject><subject>Sensitivity and Specificity</subject><subject>Studies</subject><subject>Thrombelastography</subject><subject>Trauma</subject><subject>Variables</subject><subject>Ventilation</subject><subject>Wounds and Injuries - 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drug effects</topic><topic>Blood Platelets - physiology</topic><topic>Bone surgery</topic><topic>Clinical outcomes</topic><topic>Clinical trials</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Platelet Aggregation Inhibitors - adverse effects</topic><topic>Retrospective Studies</topic><topic>Sensitivity and Specificity</topic><topic>Studies</topic><topic>Thrombelastography</topic><topic>Trauma</topic><topic>Variables</topic><topic>Ventilation</topic><topic>Wounds and Injuries - blood</topic><topic>Wounds and Injuries - physiopathology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Daley, Mitchell J.</creatorcontrib><creatorcontrib>Trust, Marc D.</creatorcontrib><creatorcontrib>Peterson, Evan J.</creatorcontrib><creatorcontrib>Luftman, Kevin</creatorcontrib><creatorcontrib>Miller, Andrew H.</creatorcontrib><creatorcontrib>Ali, Sadia</creatorcontrib><creatorcontrib>Clark, Adam</creatorcontrib><creatorcontrib>Aydelotte, Jayson D.</creatorcontrib><creatorcontrib>Coopwood, Thomas B.</creatorcontrib><creatorcontrib>Brown, Carlos V.R.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>The American surgeon</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Daley, Mitchell J.</au><au>Trust, Marc D.</au><au>Peterson, Evan J.</au><au>Luftman, Kevin</au><au>Miller, Andrew H.</au><au>Ali, Sadia</au><au>Clark, Adam</au><au>Aydelotte, Jayson D.</au><au>Coopwood, Thomas B.</au><au>Brown, Carlos V.R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Thromboelastography Does Not Detect Preinjury Antiplatelet Therapy in Acute Trauma Patients</atitle><jtitle>The American surgeon</jtitle><addtitle>Am Surg</addtitle><date>2016-02</date><risdate>2016</risdate><volume>82</volume><issue>2</issue><spage>175</spage><epage>180</epage><pages>175-180</pages><issn>0003-1348</issn><eissn>1555-9823</eissn><abstract>Thromboelastography (TEG) with platelet mapping has been proposed as an assay to detect the presence of antiplatelet agents (APA), yet no study has evaluated TEG markers of platelet dysfunction in acute trauma patients stratified by the use of preinjury APA. We hypothesized that patients on preinjury APA would demonstrate prolonged TEG markers of platelet dysfunction compared with those not on preinjury APA. This retrospective review evaluated all trauma patients admitted to a Level I trauma center from February 2011 to April 2013 who received a TEG within the first 24 hours of admission. Patients were classified as receiving preinjury APA or no APA if their documented medications included either aspirin or adenosine diphosphate (ADP) antagonists, including clopidogrel, prasugrel, and ticagrelor. A total of 129 patients were included (APA, n = 35; no APA n = 94) in the study. The time from admission to the first TEG was similar (APA 175 ± 289 minutes versus no APA 216 ± 321 minutes, P = 0.5). There was no significant difference in TEG markers of platelet dysfunction, including per cent ADP inhibition (APA 61.7 ± 25.8% versus no APA 62.3 ± 28.8%; P = 0.91) or per cent arachidonic acid inhibition (APA 58.2 ± 31% versus no APA 53.8 ± 34%; P = 0.54). Both groups had similar proportion of severe platelet dysfunction, defined as ADP inhibition greater than 70 per cent (APA 40% versus no APA 40%; P = 0.8) and arachidonic acid inhibition greater than 70 per cent (APA 40% versus no APA 39%; P = 0.89). In conclusion, platelet dysfunction after major trauma is common. Therefore, TEG alone should not be used to evaluate for the presence of APA due to apparent lack of specificity.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>26874143</pmid><doi>10.1177/000313481608200224</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | The American surgeon, 2016-02, Vol.82 (2), p.175-180 |
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| subjects | Abdomen Acute coronary syndromes Adolescent Adult Aged Aged, 80 and over Blood platelets Blood Platelets - drug effects Blood Platelets - physiology Bone surgery Clinical outcomes Clinical trials Female Humans Male Middle Aged Mortality Platelet Aggregation Inhibitors - adverse effects Retrospective Studies Sensitivity and Specificity Studies Thrombelastography Trauma Variables Ventilation Wounds and Injuries - blood Wounds and Injuries - physiopathology Young Adult |
| title | Thromboelastography Does Not Detect Preinjury Antiplatelet Therapy in Acute Trauma Patients |
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