Thrombocyte aggregometry and rotational viscoelastometry function tests in coagulopathy of polytrauma patients

Abstract text (incl. references and figure legends)

Coagulopathy (TIC) in traumatic injured patients is a highly complex process that is not yet fully understood. Blood loss, increased use of clotting factors, increased fibrinolytic activity and perturbation of platelet activation may all play a role. The aim of our present study protocol is to investigate platelet function and the coagulation cascade in polytrauma patients.

Methods:

Our prospective observational study (ClinicalTrials.gov NCT05004844) included severely injured (injury severity score (ISS) ≥16), bleeding patients aged ≥18 years from 1 September 2021. At arrival, platelet aggregometry (Multiplate) and rotational viscoelastometry (ROTEM) were performed on venous blood samples from injured patients. During ROTEM tests, EX and FIB tests were performed. In aggregometry, ADP and ASPI tests were performed. Our results were compared with mitochondrial respirometry studies of platelets isolated from parallel venous blood samples.

Results:

Platelets from polytraumatized patients (n=57) had significantly decreased ADP and arachidonic acid activated function (ADP test: 112±14 AUC vs 38±12 AUC, ASPI test 105±24 AUC vs 35±15 AUC) compared to control patients (n=48). In the EX tests and FIB tests, CT, CFT times were prolonged and MCF decreased. Platelet mitochondrial respirometry measurements were below those of the control group in the polytrauma patients, suggesting a probable impairment of platelet function (37±52 pmol/ml/sec vs 64±18 pmol/ml/sec).

Conclusions:

Our results confirm the development of TIC in polytraumatized injured patients. ADP-induced platelet activation is perturbed, with concomitant platelet mitochondrial dysfunction. In addition, the extrinsic coagulation pathway and fibrinogen polymerization are also disturbed in the patients studied; in parallel, respirometry of platelet mitochondria revealed their dysfunction.

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