Thromboelastography Does Not Detect Preinjury Antiplatelet Therapy in Acute Trauma Patients

Mitchell J. Daley, Marc D. Trust, Evan J. Peterson, Kevin Luftman, Andrew H. Miller, Sadia Ali, Adam Clark, Jayson D. Aydelotte, Thomas B. Coopwood, Carlos V R Brown

Research output: Contribution to journalArticle

6 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)175-180
Number of pages6
JournalAmerican Surgeon
Volume82
Issue number2
StatePublished - Feb 1 2016

Fingerprint

Thrombelastography
Platelet Aggregation Inhibitors
Wounds and Injuries
Therapeutics
Blood Platelets
Adenosine Diphosphate
clopidogrel
Arachidonic Acid

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Daley, M. J., Trust, M. D., Peterson, E. J., Luftman, K., Miller, A. H., Ali, S., ... Brown, C. V. R. (2016). Thromboelastography Does Not Detect Preinjury Antiplatelet Therapy in Acute Trauma Patients. American Surgeon, 82(2), 175-180.

Thromboelastography Does Not Detect Preinjury Antiplatelet Therapy in Acute Trauma Patients. / 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.

In: American Surgeon, Vol. 82, No. 2, 01.02.2016, p. 175-180.

Research output: Contribution to journalArticle

Daley, MJ, Trust, MD, Peterson, EJ, Luftman, K, Miller, AH, Ali, S, Clark, A, Aydelotte, JD, Coopwood, TB & Brown, CVR 2016, 'Thromboelastography Does Not Detect Preinjury Antiplatelet Therapy in Acute Trauma Patients', American Surgeon, vol. 82, no. 2, pp. 175-180.
Daley MJ, Trust MD, Peterson EJ, Luftman K, Miller AH, Ali S et al. Thromboelastography Does Not Detect Preinjury Antiplatelet Therapy in Acute Trauma Patients. American Surgeon. 2016 Feb 1;82(2):175-180.
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. / Thromboelastography Does Not Detect Preinjury Antiplatelet Therapy in Acute Trauma Patients. In: American Surgeon. 2016 ; Vol. 82, No. 2. pp. 175-180.
@article{9f69a622a4174f6c8c9e298926aaade2,
title = "Thromboelastography Does Not Detect Preinjury Antiplatelet Therapy in Acute Trauma Patients",
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.",
author = "Daley, {Mitchell J.} and Trust, {Marc D.} and Peterson, {Evan J.} and Kevin Luftman and Miller, {Andrew H.} and Sadia Ali and Adam Clark and Aydelotte, {Jayson D.} and Coopwood, {Thomas B.} and Brown, {Carlos V R}",
year = "2016",
month = "2",
day = "1",
language = "English (US)",
volume = "82",
pages = "175--180",
journal = "American Surgeon",
issn = "0003-1348",
publisher = "Southeastern Surgical Congress",
number = "2",

}

TY - JOUR

T1 - Thromboelastography Does Not Detect Preinjury Antiplatelet Therapy in Acute Trauma Patients

AU - Daley, Mitchell J.

AU - Trust, Marc D.

AU - Peterson, Evan J.

AU - Luftman, Kevin

AU - Miller, Andrew H.

AU - Ali, Sadia

AU - Clark, Adam

AU - Aydelotte, Jayson D.

AU - Coopwood, Thomas B.

AU - Brown, Carlos V R

PY - 2016/2/1

Y1 - 2016/2/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84975114102&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84975114102&partnerID=8YFLogxK

M3 - Article

VL - 82

SP - 175

EP - 180

JO - American Surgeon

JF - American Surgeon

SN - 0003-1348

IS - 2

ER -