Platelet activation by crushed and uncrushed muscle: a flow cytometry analysis

Background Crushed autologous muscle is used in skull base surgery in the acute phase of major arterial hemorrhage to stop bleeding. The mechanism of this is not yet clear, but is thought to involve the formation of a platelet plug, which seals the vessel wall defect but still allows ongoing blood flow to the brain. Methods In this study we use flow cytometry to replicate the in‐vivo actions of crushed muscle on platelets in whole blood. We compare the ratio of activation of platelets exposed to crushed and uncrushed muscle supernatant in control patients and in patients on antiplatelet agents. Results Crushed muscle activated platelets to a higher degree than uncrushed muscle: 5.18‐fold greater in control blood (p = 0.002); 6.53‐fold greater in aspirin‐exposed blood (p < 0.0001); and 9.4‐fold greater in clopidogrel‐exposed blood (p < 0.0001). Conclusion Crushed muscle caused a consistently increased ratio of platelet activation when compared with uncrushed muscle across all groups, adding to the evidence that at least part of its clinical effect is the result of platelet activation.