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Evaluation of lyophilized platelets as an infusible hemostatic agent in experimental non‐compressible hemorrhage in swine
Introduction: Human lyophilized platelets hold promise as a novel hemostatic infusion agent for the control of traumatic hemorrhage. Rehydrated, lyophilized platelets (Stasix) were investigated as an infusible hemostatic agent in experimental non‐compressible hemorrhage, using a porcine liver injury...
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Published in: | Journal of thrombosis and haemostasis 2009-10, Vol.7 (10), p.1663-1671 |
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creator | HAWKSWORTH, J. S. ELSTER, E. A. FRYER, D. SHEPPARD, F. MORTHOLE, V. KRISHNAMURTHY, G. TOMORI, T. BROWN, T. S. TADAKI, D. K. |
description | Introduction: Human lyophilized platelets hold promise as a novel hemostatic infusion agent for the control of traumatic hemorrhage. Rehydrated, lyophilized platelets (Stasix) were investigated as an infusible hemostatic agent in experimental non‐compressible hemorrhage, using a porcine liver injury model. Methods: Yorkshire swine underwent a grade III liver injury and uncontrolled bleeding. After 15 min, animals were infused with Stasix (n = 10) or normal saline vehicle (n = 10). At 2 h, the liver was repaired, and the animals were monitored for another4 h. Resuscitation, including blood transfusion, was administered during the hospital phase. Laboratory data, including arterial blood gas, complete blood count, thromboelastography (TEG), and coagulation parameters, were collected. All animals underwent necropsy with complete histopathologic examination. Results: Overall survival in the Stasix group [8/10 (80%)] was significantly higher than in the control group [2/10 (20%)] (P = 0.023). Mean total blood loss index (g kg−1) was lower in Stasix‐treated animals (22.2 ± 3.5) than in control animals (34.7 ± 3.4) (P = 0.019). Hemodynamic parameters were improved in the Stasix group, and a trend towards higher hemoglobin and lower lactate was observed. Coagulation and TEG parameters were not different between the groups. One surviving animal in the Stasix group had evidence of thrombi on necropsy. Conclusions: This is the first reported study to evaluate rehydrated, lyophilized platelets as an infusible hemostatic agent for non‐compressible hemorrhage. Stasix improved survival and reduced blood loss in a liver injury porcine model. However, evidence of thrombotic complications warrants further investigation prior to human use in the setting of traumatic hemorrhage. |
doi_str_mv | 10.1111/j.1538-7836.2009.03562.x |
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S. ; ELSTER, E. A. ; FRYER, D. ; SHEPPARD, F. ; MORTHOLE, V. ; KRISHNAMURTHY, G. ; TOMORI, T. ; BROWN, T. S. ; TADAKI, D. K.</creator><creatorcontrib>HAWKSWORTH, J. S. ; ELSTER, E. A. ; FRYER, D. ; SHEPPARD, F. ; MORTHOLE, V. ; KRISHNAMURTHY, G. ; TOMORI, T. ; BROWN, T. S. ; TADAKI, D. K.</creatorcontrib><description>Introduction: Human lyophilized platelets hold promise as a novel hemostatic infusion agent for the control of traumatic hemorrhage. Rehydrated, lyophilized platelets (Stasix) were investigated as an infusible hemostatic agent in experimental non‐compressible hemorrhage, using a porcine liver injury model. Methods: Yorkshire swine underwent a grade III liver injury and uncontrolled bleeding. After 15 min, animals were infused with Stasix (n = 10) or normal saline vehicle (n = 10). At 2 h, the liver was repaired, and the animals were monitored for another4 h. Resuscitation, including blood transfusion, was administered during the hospital phase. Laboratory data, including arterial blood gas, complete blood count, thromboelastography (TEG), and coagulation parameters, were collected. All animals underwent necropsy with complete histopathologic examination. Results: Overall survival in the Stasix group [8/10 (80%)] was significantly higher than in the control group [2/10 (20%)] (P = 0.023). Mean total blood loss index (g kg−1) was lower in Stasix‐treated animals (22.2 ± 3.5) than in control animals (34.7 ± 3.4) (P = 0.019). Hemodynamic parameters were improved in the Stasix group, and a trend towards higher hemoglobin and lower lactate was observed. Coagulation and TEG parameters were not different between the groups. One surviving animal in the Stasix group had evidence of thrombi on necropsy. Conclusions: This is the first reported study to evaluate rehydrated, lyophilized platelets as an infusible hemostatic agent for non‐compressible hemorrhage. Stasix improved survival and reduced blood loss in a liver injury porcine model. However, evidence of thrombotic complications warrants further investigation prior to human use in the setting of traumatic hemorrhage.</description><identifier>ISSN: 1538-7933</identifier><identifier>ISSN: 1538-7836</identifier><identifier>EISSN: 1538-7836</identifier><identifier>DOI: 10.1111/j.1538-7836.2009.03562.x</identifier><identifier>PMID: 19656278</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Animals ; Female ; Freeze Drying ; Hemorrhage - therapy ; hemostatic agent ; Hemostatic Techniques - adverse effects ; Humans ; Lacerations - complications ; Liver - injuries ; Liver Diseases - etiology ; Liver Diseases - therapy ; liver injury ; lyophilization ; Male ; Platelet Transfusion - adverse effects ; platelets ; Sus scrofa ; swine ; Thrombosis - etiology ; uncontrolled hemorrhage</subject><ispartof>Journal of thrombosis and haemostasis, 2009-10, Vol.7 (10), p.1663-1671</ispartof><rights>2009 International Society on Thrombosis and Haemostasis</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3992-ca22da73fb891b44b6760bc25441f3c15097b5beb603fa53d42750de875e4d763</citedby><cites>FETCH-LOGICAL-c3992-ca22da73fb891b44b6760bc25441f3c15097b5beb603fa53d42750de875e4d763</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19656278$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>HAWKSWORTH, J. S.</creatorcontrib><creatorcontrib>ELSTER, E. A.</creatorcontrib><creatorcontrib>FRYER, D.</creatorcontrib><creatorcontrib>SHEPPARD, F.</creatorcontrib><creatorcontrib>MORTHOLE, V.</creatorcontrib><creatorcontrib>KRISHNAMURTHY, G.</creatorcontrib><creatorcontrib>TOMORI, T.</creatorcontrib><creatorcontrib>BROWN, T. S.</creatorcontrib><creatorcontrib>TADAKI, D. K.</creatorcontrib><title>Evaluation of lyophilized platelets as an infusible hemostatic agent in experimental non‐compressible hemorrhage in swine</title><title>Journal of thrombosis and haemostasis</title><addtitle>J Thromb Haemost</addtitle><description>Introduction: Human lyophilized platelets hold promise as a novel hemostatic infusion agent for the control of traumatic hemorrhage. Rehydrated, lyophilized platelets (Stasix) were investigated as an infusible hemostatic agent in experimental non‐compressible hemorrhage, using a porcine liver injury model. Methods: Yorkshire swine underwent a grade III liver injury and uncontrolled bleeding. After 15 min, animals were infused with Stasix (n = 10) or normal saline vehicle (n = 10). At 2 h, the liver was repaired, and the animals were monitored for another4 h. Resuscitation, including blood transfusion, was administered during the hospital phase. Laboratory data, including arterial blood gas, complete blood count, thromboelastography (TEG), and coagulation parameters, were collected. All animals underwent necropsy with complete histopathologic examination. Results: Overall survival in the Stasix group [8/10 (80%)] was significantly higher than in the control group [2/10 (20%)] (P = 0.023). Mean total blood loss index (g kg−1) was lower in Stasix‐treated animals (22.2 ± 3.5) than in control animals (34.7 ± 3.4) (P = 0.019). Hemodynamic parameters were improved in the Stasix group, and a trend towards higher hemoglobin and lower lactate was observed. Coagulation and TEG parameters were not different between the groups. One surviving animal in the Stasix group had evidence of thrombi on necropsy. Conclusions: This is the first reported study to evaluate rehydrated, lyophilized platelets as an infusible hemostatic agent for non‐compressible hemorrhage. Stasix improved survival and reduced blood loss in a liver injury porcine model. However, evidence of thrombotic complications warrants further investigation prior to human use in the setting of traumatic hemorrhage.</description><subject>Animals</subject><subject>Female</subject><subject>Freeze Drying</subject><subject>Hemorrhage - therapy</subject><subject>hemostatic agent</subject><subject>Hemostatic Techniques - adverse effects</subject><subject>Humans</subject><subject>Lacerations - complications</subject><subject>Liver - injuries</subject><subject>Liver Diseases - etiology</subject><subject>Liver Diseases - therapy</subject><subject>liver injury</subject><subject>lyophilization</subject><subject>Male</subject><subject>Platelet Transfusion - adverse effects</subject><subject>platelets</subject><subject>Sus scrofa</subject><subject>swine</subject><subject>Thrombosis - etiology</subject><subject>uncontrolled hemorrhage</subject><issn>1538-7933</issn><issn>1538-7836</issn><issn>1538-7836</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><recordid>eNqNkMFO3DAQhq0KVLbAKyDfetrUjuM4PnCoVgsUIfUCZ8tOJqxXThzihN1tLzxCn7FPUofdwhXLksea7x_LH0KYkoTG9W2dUM6KuShYnqSEyIQwnqfJ9hOavTWO_teSsRP0JYQ1IVTylHxGJ1TmkRfFDP1ePms36sH6Fvsau53vVtbZX1DhzukBHAwB67hbbNt6DNY4wCtofBhiqMT6EdohtjBsO-htE2_a4da3f1_-lL7pegjvmb5fRX6iw8a2cIaOa-0CnB_OU_Rwtbxf3Mzvfl7_WHy_m5dMynRe6jSttGC1KSQ1WWZykRNTpjzLaM1KyokUhhswOWG15qzKUsFJBYXgkFUiZ6fo635u1_unEcKgGhtKcE634MegBMsIL3ImI1nsybL3IfRQqy7-Sfc7RYmazKu1mqSqSbCazKtX82oboxeHR0bTQPUePKiOwOUe2FgHuw8PVrf3N1PF_gEI1pXS</recordid><startdate>200910</startdate><enddate>200910</enddate><creator>HAWKSWORTH, J. S.</creator><creator>ELSTER, E. A.</creator><creator>FRYER, D.</creator><creator>SHEPPARD, F.</creator><creator>MORTHOLE, V.</creator><creator>KRISHNAMURTHY, G.</creator><creator>TOMORI, T.</creator><creator>BROWN, T. S.</creator><creator>TADAKI, D. K.</creator><general>Blackwell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200910</creationdate><title>Evaluation of lyophilized platelets as an infusible hemostatic agent in experimental non‐compressible hemorrhage in swine</title><author>HAWKSWORTH, J. S. ; ELSTER, E. A. ; FRYER, D. ; SHEPPARD, F. ; MORTHOLE, V. ; KRISHNAMURTHY, G. ; TOMORI, T. ; BROWN, T. S. ; TADAKI, D. K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3992-ca22da73fb891b44b6760bc25441f3c15097b5beb603fa53d42750de875e4d763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Animals</topic><topic>Female</topic><topic>Freeze Drying</topic><topic>Hemorrhage - therapy</topic><topic>hemostatic agent</topic><topic>Hemostatic Techniques - adverse effects</topic><topic>Humans</topic><topic>Lacerations - complications</topic><topic>Liver - injuries</topic><topic>Liver Diseases - etiology</topic><topic>Liver Diseases - therapy</topic><topic>liver injury</topic><topic>lyophilization</topic><topic>Male</topic><topic>Platelet Transfusion - adverse effects</topic><topic>platelets</topic><topic>Sus scrofa</topic><topic>swine</topic><topic>Thrombosis - etiology</topic><topic>uncontrolled hemorrhage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>HAWKSWORTH, J. S.</creatorcontrib><creatorcontrib>ELSTER, E. A.</creatorcontrib><creatorcontrib>FRYER, D.</creatorcontrib><creatorcontrib>SHEPPARD, F.</creatorcontrib><creatorcontrib>MORTHOLE, V.</creatorcontrib><creatorcontrib>KRISHNAMURTHY, G.</creatorcontrib><creatorcontrib>TOMORI, T.</creatorcontrib><creatorcontrib>BROWN, T. S.</creatorcontrib><creatorcontrib>TADAKI, D. K.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of thrombosis and haemostasis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>HAWKSWORTH, J. S.</au><au>ELSTER, E. A.</au><au>FRYER, D.</au><au>SHEPPARD, F.</au><au>MORTHOLE, V.</au><au>KRISHNAMURTHY, G.</au><au>TOMORI, T.</au><au>BROWN, T. S.</au><au>TADAKI, D. K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of lyophilized platelets as an infusible hemostatic agent in experimental non‐compressible hemorrhage in swine</atitle><jtitle>Journal of thrombosis and haemostasis</jtitle><addtitle>J Thromb Haemost</addtitle><date>2009-10</date><risdate>2009</risdate><volume>7</volume><issue>10</issue><spage>1663</spage><epage>1671</epage><pages>1663-1671</pages><issn>1538-7933</issn><issn>1538-7836</issn><eissn>1538-7836</eissn><abstract>Introduction: Human lyophilized platelets hold promise as a novel hemostatic infusion agent for the control of traumatic hemorrhage. Rehydrated, lyophilized platelets (Stasix) were investigated as an infusible hemostatic agent in experimental non‐compressible hemorrhage, using a porcine liver injury model. Methods: Yorkshire swine underwent a grade III liver injury and uncontrolled bleeding. After 15 min, animals were infused with Stasix (n = 10) or normal saline vehicle (n = 10). At 2 h, the liver was repaired, and the animals were monitored for another4 h. Resuscitation, including blood transfusion, was administered during the hospital phase. Laboratory data, including arterial blood gas, complete blood count, thromboelastography (TEG), and coagulation parameters, were collected. All animals underwent necropsy with complete histopathologic examination. Results: Overall survival in the Stasix group [8/10 (80%)] was significantly higher than in the control group [2/10 (20%)] (P = 0.023). Mean total blood loss index (g kg−1) was lower in Stasix‐treated animals (22.2 ± 3.5) than in control animals (34.7 ± 3.4) (P = 0.019). Hemodynamic parameters were improved in the Stasix group, and a trend towards higher hemoglobin and lower lactate was observed. Coagulation and TEG parameters were not different between the groups. One surviving animal in the Stasix group had evidence of thrombi on necropsy. Conclusions: This is the first reported study to evaluate rehydrated, lyophilized platelets as an infusible hemostatic agent for non‐compressible hemorrhage. Stasix improved survival and reduced blood loss in a liver injury porcine model. However, evidence of thrombotic complications warrants further investigation prior to human use in the setting of traumatic hemorrhage.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>19656278</pmid><doi>10.1111/j.1538-7836.2009.03562.x</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Animals Female Freeze Drying Hemorrhage - therapy hemostatic agent Hemostatic Techniques - adverse effects Humans Lacerations - complications Liver - injuries Liver Diseases - etiology Liver Diseases - therapy liver injury lyophilization Male Platelet Transfusion - adverse effects platelets Sus scrofa swine Thrombosis - etiology uncontrolled hemorrhage |
title | Evaluation of lyophilized platelets as an infusible hemostatic agent in experimental non‐compressible hemorrhage in swine |
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