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Cold-stored platelets for acute bleeding in cardiac surgical patients: a narrative review

Plaquettes conservées au froid pour les saignements aigus chez les patient·es de chirurgie cardiaque : un compte rendu narratif

  • Review Article/Brief Review
  • Published:
Canadian Journal of Anesthesia/Journal canadien d'anesthésie Aims and scope Submit manuscript

Abstract

Purpose

Cold-stored platelets (CSP) are an increasingly active topic of international research. They are maintained at 1–6 °C, in contrast to standard room-temperature platelets (RTP) kept at 20–24 °C. Recent evidence suggests that CSP have superior hemostatic properties compared with RTP. This narrative review explores the application of CSP in adult cardiac surgery, summarizes the preclinical and clinical evidence for their use, and highlights recent research.

Source

A targeted search of MEDLINE and other databases up to 24 February 2022 was conducted. Search terms combined concepts such as cardiac surgery, blood, platelet, and cold-stored. Searches of trial registries ClinicalTrials.gov and WHO International Clinical Trials Registry Platform were included. Articles were included if they described adult surgical patients as their population of interest and an association between CSP and clinical outcomes. References of included articles were hand searched.

Principal findings

When platelets are stored at 1–6 °C, their metabolic rate is slowed, preserving hemostatic function for increased storage duration. Cold-stored platelets have superior adhesion characteristics under physiologic shear conditions, and similar or superior aggregation responses to physiologic agonists. Cold-stored platelets undergo structural, metabolic, and molecular changes which appear to “prime” them for hemostatic activity. While preliminary, clinical evidence supports the conduct of trials comparing CSP with RTP for patients with platelet-related bleeding, such as those undergoing cardiac surgery.

Conclusion

Cold-stored platelets may have several advantages over RTP, including increased hemostatic capacity, extended shelf-life, and reduced risk of bacterial contamination. Large clinical trials are needed to establish their potential role in the treatment of acutely bleeding patients.

Résumé

Objectif

Les plaquettes conservées au froid (PCF) sont un sujet de recherche internationale de plus en plus populaire. Ces plaquettes sont maintenues à une température de 1-6 °C, contrairement aux plaquettes standard conservées à température ambiante (PTA), maintenues à 20–24 °C. Des données probantes récentes suggèrent que les PCF ont des propriétés hémostatiques supérieures aux PTA. Ce compte rendu narratif explore l’application de PCF en chirurgie cardiaque chez l’adulte, résume les données probantes précliniques et cliniques de leur utilisation, et met en évidence les recherches récentes.

Sources

Une recherche ciblée dans MEDLINE et d’autres bases de données jusqu’au 24 février 2022 a été effectuée. Les termes de recherche combinaient des concepts en anglais tels que cardiac surgery, blood, platelet et cold-stored (soit chirurgie cardiaque, plaquette, et entreposage frigorifique). Des recherches dans les registres d’études ClinicalTrials.gov et le système d’enregistrement international des essais cliniques (ICTRP) de l’OMS ont été incluses. Les articles ont été inclus s’ils décrivaient des patient·es adultes de chirurgie en tant que population d’intérêt et une association entre les PCF et les issues cliniques. Les références des articles inclus ont fait l’objet d’une recherche manuelle.

Constatations principales

Lorsque les plaquettes sont conservées entre 1 et 6 °C, leur taux métabolique est ralenti, préservant la fonction hémostatique pour une durée d’entreposage accrue. Les plaquettes conservées au froid ont des caractéristiques d’adhésion supérieures dans des conditions de cisaillement physiologique et des réponses d’agrégation similaires ou supérieures aux agonistes physiologiques. Les plaquettes conservées au froid subissent des changements structurels, métaboliques et moléculaires qui semblent les « amorcer » pour une activité hémostatique. Bien que préliminaires, les données probantes cliniques appuient la réalisation d’études comparant les PCF aux PTA chez la patientèle présentant des saignements liés aux plaquettes, tels que les personnes bénéficiant d’une chirurgie cardiaque.

Conclusion

Les plaquettes conservées au froid peuvent présenter plusieurs avantages par rapport aux PTA, notamment une capacité hémostatique accrue, une durée de conservation prolongée et un risque réduit de contamination bactérienne. De grands essais cliniques sont nécessaires pour établir leur rôle potentiel dans le traitement de la patientèle en hémorragie aiguë.

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Author contributions

Justin Lu contributed to the conception of the study, data collection, and writing the first draft of the manuscript. Keyvan Karkouti and Jeannie Callum contributed to the conception of the study, interpretation of data, and revision of manuscript drafts. Miki Peer, Philip C. Spinella, Torunn Apelseth, Thomas G. Scorer, Walter H. A. Kahr, Mark McVey, Vivek Rao, Lusine Abrahamyan, Lani Lieberman, Holly Mewhort, and Dana Devine contributed to the interpretation of data and revision of manuscript drafts. Marina Englesakis contributed to the conception, design, and execution of database search strategies, management and curation of database results, and review of manuscript drafts. Justyna Bartoszko contributed to the conception of the study, data collection, writing the first draft of manuscript, study design and analysis, and revision of manuscript drafts. All authors contributed to manuscript concept, content, and writing.

Disclosures

Justyna Bartoszko is in part supported by a merit award from the Department of Anesthesiology and Pain Medicine, University of Toronto and has received honoraria from Octapharma AG (Lachen, Switzerland). Keyvan Karkouti is in part supported by a merit award from the Department of Anesthesiology and Pain Medicine, University of Toronto. He has received research support, honoraria, or consultancy for speaking engagements from Octapharma AG, Instrumentation Laboratory Co. (Bedford, MA, USA), and Bayer AG (Leverkusen, Germany). Jeannie Callum has received research support from Canadian Blood Services and Octapharma AG. Philip C. Spinella is a consultant for Secure Transfusion Solutions (San Francisco, CA, USA).

Funding statement

No sources of funding are declared.

Disclaimer

The opinions or assertations contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Norwegian Armed Forces Medical Services.

Editorial responsibility

This submission was handled by Dr. Philip M. Jones, Deputy Editor-in-Chief, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

Author information

Authors and Affiliations

  1. Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Justin Lu MD

  2. Department of Anesthesia and Pain Management, Sinai Health System, Women’s College Hospital, University Health Network, Toronto General Hospital, Toronto, ON, Canada

    Keyvan Karkouti MD, MSc, FRCPC & Miki Peer PhD

  3. Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada

    Keyvan Karkouti MD, MSc, FRCPC, Mark McVey MD, PhD, FRCPC & Justyna Bartoszko MD, MSc, FRCPC

  4. Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada

    Keyvan Karkouti MD, MSc, FRCPC & Justyna Bartoszko MD, MSc, FRCPC

  5. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada

    Keyvan Karkouti MD, MSc, FRCPC

  6. Library & Information Services, University Health Network, Toronto, ON, Canada

    Marina Englesakis HBA, MLIS

  7. Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Philip C. Spinella MD, FCCM

  8. Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    Philip C. Spinella MD, FCCM

  9. Department of Immunology and Transfusion Medicine, Haukeland University Hospital, University of Bergen, Bergen, Norway

    Torunn O. Apelseth MD, PhD

  10. Norwegian Armed Forces Joint Medical Services, Norwegian Armed Forces, Oslo, Norway

    Torunn O. Apelseth MD, PhD

  11. Centre of Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK

    Thomas G. Scorer MBBS, MRCP, FRCPath, RN

  12. School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK

    Thomas G. Scorer MBBS, MRCP, FRCPath, RN

  13. Division of Haematology/Oncology, The Hospital for Sick Children (SickKids), Toronto, ON, Canada

    Walter H. A. Kahr MD, PhD, FRCPC

  14. Cell Biology Program, SickKids Research Institute, Toronto, ON, Canada

    Walter H. A. Kahr MD, PhD, FRCPC

  15. Departments of Paediatrics and Biochemistry, University of Toronto, Toronto, ON, Canada

    Walter H. A. Kahr MD, PhD, FRCPC

  16. Department of Anesthesia and Pain Medicine, The Hospital for Sick Children (SickKids), Toronto, ON, Canada

    Mark McVey MD, PhD, FRCPC

  17. Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada

    Mark McVey MD, PhD, FRCPC

  18. Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada

    Vivek Rao MD, PhD, FRCSC

  19. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Lusine Abrahamyan MD, MPH, PhD

  20. Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Research Institute, Toronto, ON, Canada

    Lusine Abrahamyan MD, MPH, PhD

  21. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada

    Lani Lieberman MD, FRCPC

  22. Department of Surgery, School of Medicine, Queen’s University, Kingston, ON, Canada

    Holly Mewhort MD, PhD, FRCSC

  23. Canadian Blood Services, Vancouver, BC, Canada

    Dana V. Devine MA, PhD

  24. Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, BC, Canada

    Dana V. Devine MA, PhD

  25. Quality in Utilization, Education and Safety in Transfusion Research Program, University of Toronto, Toronto, ON, Canada

    Jeannie Callum MD, FRCPC

  26. Department of Pathology and Molecular Medicine, School of Medicine, Queen’s University, Kingston, ON, Canada

    Jeannie Callum MD, FRCPC

  27. Kingston Health Sciences Centre, Kingston General Hospital, Kingston, ON, Canada

    Jeannie Callum MD, FRCPC

  28. Department of Anesthesia and Pain Management, Sinai Health System, Women’s College Hospital, University Health Network, Toronto General Hospital, 200 Elizabeth Street, 3EN-464, Toronto, ON, M5G 2C4, Canada

    Justyna Bartoszko MD, MSc, FRCPC

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  1. Justin Lu MD
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  2. Keyvan Karkouti MD, MSc, FRCPC
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  15. Jeannie Callum MD, FRCPC
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  16. Justyna Bartoszko MD, MSc, FRCPC
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Correspondence to Justyna Bartoszko MD, MSc, FRCPC.

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Lu, J., Karkouti, K., Peer, M. et al. Cold-stored platelets for acute bleeding in cardiac surgical patients: a narrative review. Can J Anesth/J Can Anesth 70, 1682–1700 (2023). https://doi.org/10.1007/s12630-023-02561-9

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