期刊
TRANSFUSION
卷 55, 期 2, 页码 314-325出版社
WILEY
DOI: 10.1111/trf.12829
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-
类别
资金
- Ministry of Health, Labor and Welfare, Japan
- Grants-in-Aid for Scientific Research [25504021, 25462843, 25293369] Funding Source: KAKEN
BackgroundWe evaluated the hemostatic efficacy of H12-(adenosine 5-diphosphate [ADP])-liposomes in the setting of active liver bleeding in rabbits with dilutional thrombocytopenia after massive transfusion. Study Design and MethodsAcute thrombocytopenia (platelet [PLT] count<50x10(9)/L) was induced in rabbits by repeated blood withdrawal and isovolemic transfusion of autologous washed red blood cells. Liver hemorrhage was initiated by a penetrating liver injury. Subsequently, the animals received tamponade treatment for the liver hemorrhage for 5 minutes and were intravenously administered H12-(ADP)-liposomes with PLT-poor plasma (PPP), PLT-rich plasma (PRP), PPP alone, H12-(phosphate-buffered saline [PBS])-liposome/PPP, or H12-(ADP)-liposomes/PPPplusfibrinogen concentrate during the tamponade. ResultsAdministration of H12-(ADP)-liposomes/PPP rescued 60% of the rabbits from the liver hemorrhage; PRP administration rescued 50%. In contrast, rabbits receiving PPP or H12-(PBS)-liposome/PPP achieved only 10 or 17% survival, respectively, for the first 24 hours. H12-(ADP)-liposomes/PPP as well as PRP consistently reduced bleeding volumes and shortened clotting times (CTs) in comparison to PPP administration. Specifically, bleeding volumes in the initial 5 minutes averaged 11mL (H12-(ADP)-liposomes/PPP) and 17mL (PRP) versus 30mL (PPP; p<0.05); CTs averaged 270 and 306 seconds versus 401 seconds (p<0.05). H12-(ADP)-liposomes were observed at the bleeding site with thrombus formation, suggesting an induction of thrombi. Neither macro- nor microthrombi were detected in the lung, kidney, spleen, or liver in rabbits treated with H12-(ADP)-liposomes. Supplementation of fibrinogen to H12-(ADP)-liposomes/PPP did not significantly improve rabbit survival. ConclusionsH12-(ADP)-liposomes might be a safe and effective therapeutic tool during damage control surgery for trauma patients with acute thrombocytopenia and massive bleeding.
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