A Novel Platelet Function Assay for Trauma

Background: Platelet function tests such as thrombelastography platelet mapping and impedance aggregometry have demonstrated universal platelet dysfunction in trauma patients. In this study, we introduce the measurement of platelet contraction force as a test of platelet function. We hypothesize that force will correlate with established coagulation tests such as thrombelastography, demonstrate significant differences between healthy subjects and trauma patients, and identify critically ill trauma patients. Methods: Blood samples were prospectively collected from level 1 trauma patients at initial presentation, assayed for force of and time to contraction and compared with thrombelastography. Blood from healthy subjects was assayed to establish a reference range. Results from trauma patients were compared with healthy controls and trauma patients that died. Results: The study includes one hundred trauma patients with mean age 45 y, 74% were male, and median injury severity score of 14 +/- 12. Patients that survived (n = 90) demonstrated significantly elevated platelet contraction force compared with healthy controls (n = 12) (6390 +/- 2340 versus 4790 +/- 470 mN, P = 0.043) and trauma patients that died (n = 10) (6390 +/- 2340 versus 2860 +/- 1830 mN, P = 0.0001). Elapsed time to start of platelet contraction was faster in trauma patients that survived compared with healthy controls (660 +/- 467 versus 1130 +/- 140 s, P = 0.0022) and those that died (660 +/- 470 versus 1460 +/- 1340 s, P < 0.0001). Conclusions: In contrast with all existing platelet function tests reported in the literature, which report platelet dysfunction in trauma patients, contractile force demonstrates hyperfunction in surviving trauma patients and dysfunction in nonsurvivors. Platelet contraction reflects platelet metabolic reserve and thus may be a potential biomarker for survival after trauma. Contractile force warrants further investigation to predict mortality in severely injured trauma patients. (C) 2019 Elsevier Inc. All rights reserved.