Ashley Bartels MD, Charles Jones BS, Alexander Scott BS, Jared Coberly MD, Jacob Quick MD, RIchard Hammer MD
Journal of Anesthesia & Surgery - SDRP
VOLUME: 2 ISSUE: 2
Salman Ahmad MD, FACS, Thromboelastography with Platelet Mapping as an Alternative for the Platelet Function Assay-100 in Detecting Clopidogrel in Trauma Patients(2017)SDRP Journal of Anesthesia & Surgery 2(2)
Antiplatelet therapy is prevalent and can potentiate bleeding complications associated with trauma and surgery. Laboratory identification and quantification of the effect of antiplatelet medications has been difficult, with several assays, including the Platelet Function Assay [PFA]-100, yielding inconclusive results. The purpose of this study was to evaluate the effectiveness of thromboelastography with platelet mapping (TEG-PM) to identify the presence of antiplatelet medications and compare these results with the PFA-100.
All trauma patients with TEG-PM studies from September 2013 to September 2014 were retrospectively collected. The medical records were reviewed to determine home antiplatelet medications. Patients were then evaluated for concurrent PFA-100 tests to allow direct comparison of the studies.
Twenty-one patients had both TEG-PM and PFA-100 test performed. In this set of patients, the sensitivity and specificity of the PFA for detecting antiplatelet medications was 50.0% and 61.9%, respectively; the TEG-PM had 88.9% sensitivity and 41.7% specificity for detecting aspirin and 100% sensitivity and 8.3% specificity for detecting clopidogrel.
Thromboelastography with platelet mapping was more sensitive for detecting both aspirin and clopidogrel than the PFA-100; the 100% sensitivity in detecting clopidogrel is key and indicates this may be a useful screening tool to rule out clopidogrel use in trauma patients. Interestingly, there is a very low specificity, which may be related to acute traumatic coagulopathy.
Thromboelastography, Antiplatelet, Trauma, Acute traumatic coagulopathy
Noel P, Cashen S, Patel B. Trauma-Induced coagulopathy: From biology to therapy. Semin Hematol. 2013;50(3):259-269. doi:10.1053/j.seminhematol.2013.06.009.View Article
Cap A, Hunt B, Beckers SK, et al. Acute traumatic coagulopathy. Curr Opin Crit Care. 2014;20(6):620-625. doi:10.1097/MCC.0000000000000160.View Article
Cardenas JC, Wade CE, Holcomb JB. Mechanisms of trauma-induced coagulopathy. Curr Opin Hematol. 2014;21(5):404-409. doi:10.1097/MOH.0000000000000063.View Article
Cohen MJ. Acute traumatic coagulopathy: Clinical characterization and mechanistic investigation. Thromb Res. 2014;133(SUPPL. 1):S25-S27. doi:10.1016/j.thromres.2014.03.013.View Article
Stuntz M, Bernstein B. Recent trends in the prevalence of low-dose aspirin use for primary and secondary prevention of cardiovascular disease in the United States, 2012?2015 ?. Prev Med Reports2. 2017;5:183-186. doi:10.1016/j.pmedr.2016.12.023.View Article
Mina A a, Knipfer JF, Park DY, Bair H a, Howells G a, Bendick PJ. Intracranial complications of preinjury anticoagulation in trauma patients with head injury. J Trauma. 2002;53(4):668-672. doi:10.1097/01.TA.0000025291.29067.E9.
Ohm C, Mina A, Howells G, Bair H, Bendick P. Effects of Antiplatelet Agents on Outcomes for Elderly Patients With Traumatic Intracranial Hemorrhage. J Trauma Inj Infect Crit Care. 2005;58(3):518-522. doi:10.1097/01.TA.0000151671.35280.8B.View Article
Ivascu F a, Howells G a, Junn FS, Bair H a, Bendick PJ, Janczyk RJ. Predictors of mortality in trauma patients with intracranial hemorrhage on preinjury aspirin or clopidogrel. J Trauma. 2008;65(4):785-788. doi:10.1097/TA.0b013e3181848caa.View Article
Jones K, Sharp C, Mangram A, Dunn EL. The effects of preinjury clopidogrel use on older trauma patients with head injuries. American Journal of Surgery. . Published 2006. Accessed April 26, 2015.View Article
Bartels A, Sarpong Y, Coberly J, et al. Failure of the Platelet Function Assay (PFA)-100 to detect antiplatelet agents. Surg (United States). 2015;158(4). doi:10.1016/j.surg.2015.07.011.View Article
Whiting D, DiNardo J a. TEG and ROTEM: technology and clinical applications. Am J Hematol. 2014;89(2):228-232. doi:10.1002/ajh.23599.View Article
Hayward CPM, Harrison P, Cattaneo M, Ortel TL, Rao a. K. Platelet function analyzer (PFA)-100? closure time in the evaluation of platelet disorders and platelet function. J Thromb Haemost. 2006;4(2):312-319. doi:10.1111/j.1538-7836.2006.01771.x.View Article
Briggs A, Gates JD, Kaufman RM, Calahan C, Gormley WB, Havens JM. Platelet dysfunction and platelet transfusion in traumatic brain injury. J Surg Res. 2015;193(2):802-806. doi:10.1016/j.jss.2014.08.016.View Article
Kutcher M, Redick B, McCreery R. Characterization of platelet dysfunction after trauma. J Trauma Acute Care Surg. 2012;73:13-19. PMid:22743367 PMCid:PMC3387387View Article PubMed/NCBI
Epstein DS, Mitra B, O'Reilly G, Rosenfeld J V., Cameron PA. Acute traumatic coagulopathy in the setting of isolated traumatic brain injury: A systematic review and meta-analysis. Injury. 2014;45(5):819-824. doi:10.1016/j.injury.2014.01.011.View Article
Nekludov M, Bellander B-M, Blomb?ck M, Wallen HN. Platelet dysfunction in patients with severe traumatic brain injury. J Neurotrauma. 2007;24(11):1699-1706. doi:10.1089/neu.2007.0322.View Article
Pareti FI, Capitanio A, Mannucci L, Ponticelli C, Mannucci PM. Acquired dysfunction due to the circulation of "exhausted" platelets. Am J Med. 1980;69(2):235-240. 90383-6View Article