Post-Injury Platelet Biology: Mechanisms and Outcomes

Blood Platelets Clinical Trial

Official title:

Post-Injury Platelet Biology: Mechanisms and Outcomes

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03682757
• Other study ID #: P0528296
• Secondary ID: 5K23GM130892
• Status: Completed
• Start date: September 20, 2018
• Est. completion date: September 30, 2023

Study information

• Verified date: December 2023
• Source: University of California, San Francisco
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

Trauma-induced coagulopathy is a central cause of preventable deaths from hemorrhage after injury. The contribution and impact of altered post injury platelet biology on trauma-induced coagulopathy is not well understood despite the pivotal contribution of platelets to normal coagulation and endothelial integrity. The central hypothesis for this study is that severe injury and shock drive altered platelet activation, platelet aggregation, and platelet-endothelial interactions that are associated with increased rates of transfusion, organ failure, and mortality. This study will investigate these causal pathways, mechanisms, and associated outcomes in a prospective observational trauma cohort through collection of biospecimens and detailed clinical data.

Description:

This is a prospective cohort study of trauma patients on admission to the emergency department and for the subsequent 28 days. All adult patients meeting criteria for full trauma team activation and admitted to Zuckerberg San Francisco General Hospital and Trauma center, a level-1 trauma center, are eligible for enrollment. A 20-ml sample of blood will be drawn within 10 minutes of arrival in the emergency department (ED), processed in the central laboratory, and plasma stored at -80°C. Blood samples will be collected immediately on presentation via initial placement of a 16-gauge or larger peripheral intravenous line. Plasma biomarkers of endothelial injury will be measured by enzyme-linked immunosorbent assays (von Willebrand factor, syndecan-1, and angiopoietin-2). Cellular biomarkers of platelet activation will be measured by flow cytometry (platelet-monocyte aggregates, integrin αIIbβ3, P-selectin, and platelet microparticles). Platelet aggregation will be measured by whole blood multiple electrode impedance aggregometry. The effect of post-injury platelets on endothelial integrity will be quantified by in vitro assays of platelet-induced endothelial permeability. Comprehensive demographic data and medical history will be collected from chart review, interviews of patients and family members. Detailed clinical and outcome data is collected including transfusion timing and doses, the incidence of organ failure (Denver Postinjury Multiple Organ Failure Score), acute respiratory distress syndrome (Berlin Definition), infection, symptomatic thromboembolic complications, ventilator-free days, length of intensive care unit (ICU) and hospital stay, and mortality (6 hours, 24 hours, 30 days). In hospital mortality after 30 days will be assessed for all patients. Standard coagulation measures (international normalized ratio, prothrombin time, platelet count) and other laboratory measures will be collected to account and control for other distinct but highly integrated pathways implicated in trauma-induced coagulopathy. The Trauma Registry, a large database managed under guidelines from the American Trauma society, uses chart review to retrospectively assign Injury Severity Scores (ISS) and Abbreviated Injury Scores (AIS).

Recruitment information / eligibility

• Status: Completed
• Enrollment: 367
• Est. completion date: September 30, 2023
• Est. primary completion date: September 30, 2023
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Adult patients meeting criteria for full trauma team activation and admitted to Zuckerberg San Francisco General Hospital.

Exclusion Criteria:

• Patients <18 years old
• Patients transferred from other hospitals
• Patients who are pregnant
• Patients who are incarcerated
• Patients will be retrospectively excluded if they were taking anticoagulant or anti-platelet medications, have moderate or severe liver disease, or a known bleeding diathesis.

Related Conditions & MeSH terms

• Blood Platelets
• Endothelium
• Wound and Injuries
• Wounds and Injuries

Locations

Country	Name	City	State
United States	Zuckerberg San Francisco General Hospital	San Francisco	California

Sponsors (5)

Lead Sponsor	Collaborator
University of California, San Francisco	National Institute of General Medical Sciences (NIGMS), University of California, Berkeley, University of Colorado, Denver, University of Utah

Country where clinical trial is conducted

United States, 

References & Publications (53)

ARDS Definition Task Force; Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012 Jun 20;307(23):2526-33. doi: 10.1001/jama.2012.5669. — View Citation

Baimukanova G, Miyazawa B, Potter DR, Gibb SL, Keating S, Danesh A, Beyer A, Dayter Y, Bruhn R, Muench MO, Cap AP, Norris PJ, Spinella P, Cohen M, Pati S. The effects of 22 degrees C and 4 degrees C storage of platelets on vascular endothelial integrity and function. Transfusion. 2016 Mar;56 Suppl 1:S52-64. doi: 10.1111/trf.13455. — View Citation

Baimukanova G, Miyazawa B, Potter DR, Muench MO, Bruhn R, Gibb SL, Spinella PC, Cap AP, Cohen MJ, Pati S. Platelets regulate vascular endothelial stability: assessing the storage lesion and donor variability of apheresis platelets. Transfusion. 2016 Mar;56 Suppl 1(Suppl 1):S65-75. doi: 10.1111/trf.13532. — View Citation

Baker SP, Whitfield RA, O'Neill B. Geographic variations in mortality from motor vehicle crashes. N Engl J Med. 1987 May 28;316(22):1384-7. doi: 10.1056/NEJM198705283162206. — View Citation

Bhandari V, Choo-Wing R, Lee CG, Zhu Z, Nedrelow JH, Chupp GL, Zhang X, Matthay MA, Ware LB, Homer RJ, Lee PJ, Geick A, de Fougerolles AR, Elias JA. Hyperoxia causes angiopoietin 2-mediated acute lung injury and necrotic cell death. Nat Med. 2006 Nov;12(11):1286-93. doi: 10.1038/nm1494. Epub 2006 Nov 5. — View Citation

Briggs A, Gates JD, Kaufman RM, Calahan C, Gormley WB, Havens JM. Platelet dysfunction and platelet transfusion in traumatic brain injury. J Surg Res. 2015 Feb;193(2):802-6. doi: 10.1016/j.jss.2014.08.016. Epub 2014 Aug 13. — View Citation

Brohi K, Cohen MJ, Ganter MT, Matthay MA, Mackersie RC, Pittet JF. Acute traumatic coagulopathy: initiated by hypoperfusion: modulated through the protein C pathway? Ann Surg. 2007 May;245(5):812-8. doi: 10.1097/01.sla.0000256862.79374.31. — View Citation

Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma. 2003 Jun;54(6):1127-30. doi: 10.1097/01.TA.0000069184.82147.06. — View Citation

Brown LM, Call MS, Margaret Knudson M, Cohen MJ; Trauma Outcomes Group; Holcomb JB, Wade CE, Brasel KJ, Vercruysse G, MacLeod J, Dutton RP, Hess JR, Duchesne JC, McSwain NE, Muskat P, Johannigamn J, Cryer HM, Tillou A, Pittet JF, De Moya MA, Schreiber MA, Tieu B, Brundage S, Napolitano LM, Brunsvold M, Brunsvold M, Beilman G, Peitzman AB, Zenait MS, Sperry J, Alarcon L, Croce MA, Minei JP, Kozar R, Gonzalez EA, Stewart RM, Cohn SM, Mickalek JE, Bulger EM, Cotton BA, Nunez TC, Ivatury R, Meredith JW, Miller P, Pomper GJ, Marin B. A normal platelet count may not be enough: the impact of admission platelet count on mortality and transfusion in severely injured trauma patients. J Trauma. 2011 Aug;71(2 Suppl 3):S337-42. doi: 10.1097/TA.0b013e318227f67c. — View Citation

Calfee CS, Gallagher D, Abbott J, Thompson BT, Matthay MA; NHLBI ARDS Network. Plasma angiopoietin-2 in clinical acute lung injury: prognostic and pathogenetic significance. Crit Care Med. 2012 Jun;40(6):1731-7. doi: 10.1097/CCM.0b013e3182451c87. — View Citation

Cannon JW. Hemorrhagic Shock. N Engl J Med. 2018 Jan 25;378(4):370-379. doi: 10.1056/NEJMra1705649. No abstract available. — View Citation

Cohen MJ, Christie SA. New understandings of post injury coagulation and resuscitation. Int J Surg. 2016 Sep;33(Pt B):242-245. doi: 10.1016/j.ijsu.2016.05.037. Epub 2016 May 19. — View Citation

Davenport RA, Brohi K. Coagulopathy in trauma patients: importance of thrombocyte function? Curr Opin Anaesthesiol. 2009 Apr;22(2):261-6. doi: 10.1097/ACO.0b013e328325a6d9. — View Citation

Davis PK, Musunuru H, Walsh M, Cassady R, Yount R, Losiniecki A, Moore EE, Wohlauer MV, Howard J, Ploplis VA, Castellino FJ, Thomas SG. Platelet dysfunction is an early marker for traumatic brain injury-induced coagulopathy. Neurocrit Care. 2013 Apr;18(2):201-8. doi: 10.1007/s12028-012-9745-6. — View Citation

Ding N, Chen G, Hoffman R, Loughran PA, Sodhi CP, Hackam DJ, Billiar TR, Neal MD. Toll-like receptor 4 regulates platelet function and contributes to coagulation abnormality and organ injury in hemorrhagic shock and resuscitation. Circ Cardiovasc Genet. 2014 Oct;7(5):615-24. doi: 10.1161/CIRCGENETICS.113.000398. Epub 2014 Jul 21. — View Citation

Donahue DL, Beck J, Fritz B, Davis P, Sandoval-Cooper MJ, Thomas SG, Yount RA, Walsh M, Ploplis VA, Castellino FJ. Early platelet dysfunction in a rodent model of blunt traumatic brain injury reflects the acute traumatic coagulopathy found in humans. J Neurotrauma. 2014 Feb 15;31(4):404-10. doi: 10.1089/neu.2013.3089. Epub 2013 Nov 21. — View Citation

Fiedler U, Scharpfenecker M, Koidl S, Hegen A, Grunow V, Schmidt JM, Kriz W, Thurston G, Augustin HG. The Tie-2 ligand angiopoietin-2 is stored in and rapidly released upon stimulation from endothelial cell Weibel-Palade bodies. Blood. 2004 Jun 1;103(11):4150-6. doi: 10.1182/blood-2003-10-3685. Epub 2004 Feb 19. — View Citation

Gonzalez Rodriguez E, Ostrowski SR, Cardenas JC, Baer LA, Tomasek JS, Henriksen HH, Stensballe J, Cotton BA, Holcomb JB, Johansson PI, Wade CE. Syndecan-1: A Quantitative Marker for the Endotheliopathy of Trauma. J Am Coll Surg. 2017 Sep;225(3):419-427. doi: 10.1016/j.jamcollsurg.2017.05.012. Epub 2017 Jun 1. — View Citation

Hess JR, Brohi K, Dutton RP, Hauser CJ, Holcomb JB, Kluger Y, Mackway-Jones K, Parr MJ, Rizoli SB, Yukioka T, Hoyt DB, Bouillon B. The coagulopathy of trauma: a review of mechanisms. J Trauma. 2008 Oct;65(4):748-54. doi: 10.1097/TA.0b013e3181877a9c. — View Citation

Jacoby RC, Owings JT, Holmes J, Battistella FD, Gosselin RC, Paglieroni TG. Platelet activation and function after trauma. J Trauma. 2001 Oct;51(4):639-47. doi: 10.1097/00005373-200110000-00003. — View Citation

Johansson PI, Henriksen HH, Stensballe J, Gybel-Brask M, Cardenas JC, Baer LA, Cotton BA, Holcomb JB, Wade CE, Ostrowski SR. Traumatic Endotheliopathy: A Prospective Observational Study of 424 Severely Injured Patients. Ann Surg. 2017 Mar;265(3):597-603. doi: 10.1097/SLA.0000000000001751. — View Citation

Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma. 2006 Jun;60(6 Suppl):S3-11. doi: 10.1097/01.ta.0000199961.02677.19. — View Citation

Kornblith LZ, Kutcher ME, Redick BJ, Calfee CS, Vilardi RF, Cohen MJ. Fibrinogen and platelet contributions to clot formation: implications for trauma resuscitation and thromboprophylaxis. J Trauma Acute Care Surg. 2014 Feb;76(2):255-6; discussion 262-3. doi: 10.1097/TA.0000000000000108. — View Citation

Kozar RA, Pati S. Syndecan-1 restitution by plasma after hemorrhagic shock. J Trauma Acute Care Surg. 2015 Jun;78(6 Suppl 1):S83-6. doi: 10.1097/TA.0000000000000631. No abstract available. — View Citation

Kutcher ME, Redick BJ, McCreery RC, Crane IM, Greenberg MD, Cachola LM, Nelson MF, Cohen MJ. Characterization of platelet dysfunction after trauma. J Trauma Acute Care Surg. 2012 Jul;73(1):13-9. doi: 10.1097/TA.0b013e318256deab. — View Citation

Li R, Elmongy H, Sims C, Diamond SL. Ex vivo recapitulation of trauma-induced coagulopathy and preliminary assessment of trauma patient platelet function under flow using microfluidic technology. J Trauma Acute Care Surg. 2016 Mar;80(3):440-9. doi: 10.1097/TA.0000000000000915. — View Citation

MacLeod JB, Lynn M, McKenney MG, Cohn SM, Murtha M. Early coagulopathy predicts mortality in trauma. J Trauma. 2003 Jul;55(1):39-44. doi: 10.1097/01.TA.0000075338.21177.EF. — View Citation

Michelson AD, Barnard MR, Hechtman HB, MacGregor H, Connolly RJ, Loscalzo J, Valeri CR. In vivo tracking of platelets: circulating degranulated platelets rapidly lose surface P-selectin but continue to circulate and function. Proc Natl Acad Sci U S A. 1996 Oct 15;93(21):11877-82. doi: 10.1073/pnas.93.21.11877. — View Citation

Michelson AD, Barnard MR, Krueger LA, Valeri CR, Furman MI. Circulating monocyte-platelet aggregates are a more sensitive marker of in vivo platelet activation than platelet surface P-selectin: studies in baboons, human coronary intervention, and human acute myocardial infarction. Circulation. 2001 Sep 25;104(13):1533-7. doi: 10.1161/hc3801.095588. — View Citation

Moore FA, Sauaia A, Moore EE, Haenel JB, Burch JM, Lezotte DC. Postinjury multiple organ failure: a bimodal phenomenon. J Trauma. 1996 Apr;40(4):501-10; discussion 510-2. doi: 10.1097/00005373-199604000-00001. — View Citation

Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet. 1997 May 3;349(9061):1269-76. doi: 10.1016/S0140-6736(96)07493-4. — View Citation

Nachman RL, Rafii S. Platelets, petechiae, and preservation of the vascular wall. N Engl J Med. 2008 Sep 18;359(12):1261-70. doi: 10.1056/NEJMra0800887. No abstract available. — View Citation

Naumann DN, Hazeldine J, Davies DJ, Bishop J, Midwinter MJ, Belli A, Harrison P, Lord JM. Endotheliopathy of Trauma is an on-Scene Phenomenon, and is Associated with Multiple Organ Dysfunction Syndrome: A Prospective Observational Study. Shock. 2018 Apr;49(4):420-428. doi: 10.1097/SHK.0000000000000999. — View Citation

Naumann DN, Hazeldine J, Dinsdale RJ, Bishop JR, Midwinter MJ, Harrison P, Hutchings SD, Lord JM. Endotheliopathy is associated with higher levels of cell-free DNA following major trauma: A prospective observational study. PLoS One. 2017 Dec 19;12(12):e0189870. doi: 10.1371/journal.pone.0189870. eCollection 2017. — View Citation

Norton R, Kobusingye O. Injuries. N Engl J Med. 2013 May 2;368(18):1723-30. doi: 10.1056/NEJMra1109343. No abstract available. — View Citation

Ong T, McClintock DE, Kallet RH, Ware LB, Matthay MA, Liu KD. Ratio of angiopoietin-2 to angiopoietin-1 as a predictor of mortality in acute lung injury patients. Crit Care Med. 2010 Sep;38(9):1845-51. doi: 10.1097/CCM.0b013e3181eaa5bf. — View Citation

Pati S, Potter DR, Baimukanova G, Farrel DH, Holcomb JB, Schreiber MA. Modulating the endotheliopathy of trauma: Factor concentrate versus fresh frozen plasma. J Trauma Acute Care Surg. 2016 Apr;80(4):576-84; discussion 584-5. doi: 10.1097/TA.0000000000000961. — View Citation

Peng Z, Pati S, Potter D, Brown R, Holcomb JB, Grill R, Wataha K, Park PW, Xue H, Kozar RA. Fresh frozen plasma lessens pulmonary endothelial inflammation and hyperpermeability after hemorrhagic shock and is associated with loss of syndecan 1. Shock. 2013 Sep;40(3):195-202. doi: 10.1097/SHK.0b013e31829f91fc. — View Citation

Potter DR, Baimukanova G, Keating SM, Deng X, Chu JA, Gibb SL, Peng Z, Muench MO, Fomin ME, Spinella PC, Kozar R, Pati S. Fresh frozen plasma and spray-dried plasma mitigate pulmonary vascular permeability and inflammation in hemorrhagic shock. J Trauma Acute Care Surg. 2015 Jun;78(6 Suppl 1):S7-S17. doi: 10.1097/TA.0000000000000630. — View Citation

Rondina MT, Carlisle M, Fraughton T, Brown SM, Miller RR 3rd, Harris ES, Weyrich AS, Zimmerman GA, Supiano MA, Grissom CK. Platelet-monocyte aggregate formation and mortality risk in older patients with severe sepsis and septic shock. J Gerontol A Biol Sci Med Sci. 2015 Feb;70(2):225-31. doi: 10.1093/gerona/glu082. Epub 2014 Jun 10. — View Citation

Rondina MT, Grissom CK, Men S, Harris ES, Schwertz H, Zimmerman GA, Weyrich AS. Whole blood flow cytometry measurements of in vivo platelet activation in critically-Ill patients are influenced by variability in blood sampling techniques. Thromb Res. 2012 Jun;129(6):729-35. doi: 10.1016/j.thromres.2011.11.031. Epub 2011 Dec 16. — View Citation

Sapru A, Calfee CS, Liu KD, Kangelaris K, Hansen H, Pawlikowska L, Ware LB, Alkhouli MF, Abbott J, Matthay MA; NHLBI ARDS Network. Plasma soluble thrombomodulin levels are associated with mortality in the acute respiratory distress syndrome. Intensive Care Med. 2015 Mar;41(3):470-8. doi: 10.1007/s00134-015-3648-x. Epub 2015 Feb 3. Erratum In: Intensive Care Med. 2015 Mar;41(3):574. Abbot, Jason [corrected to Abbott, Jason]. — View Citation

Sauaia A, Moore EE, Johnson JL, Ciesla DJ, Biffl WL, Banerjee A. Validation of postinjury multiple organ failure scores. Shock. 2009 May;31(5):438-47. doi: 10.1097/SHK.0b013e31818ba4c6. — View Citation

Sauaia A, Moore FA, Moore EE, Lezotte DC. Early risk factors for postinjury multiple organ failure. World J Surg. 1996 May;20(4):392-400. doi: 10.1007/s002689900062. — View Citation

Scope A, Farkash U, Lynn M, Abargel A, Eldad A. Mortality epidemiology in low-intensity warfare: Israel Defense Forces' experience. Injury. 2001 Jan;32(1):1-3. doi: 10.1016/s0020-1383(00)00101-7. — View Citation

Shih L, Kaplan D, Kraiss LW, Casper TC, Pendleton RC, Peters CL, Supiano MA, Zimmerman GA, Weyrich AS, Rondina MT. Platelet-Monocyte Aggregates and C-Reactive Protein are Associated with VTE in Older Surgical Patients. Sci Rep. 2016 Jun 7;6:27478. doi: 10.1038/srep27478. — View Citation

Solomon C, Traintinger S, Ziegler B, Hanke A, Rahe-Meyer N, Voelckel W, Schochl H. Platelet function following trauma. A multiple electrode aggregometry study. Thromb Haemost. 2011 Aug;106(2):322-30. doi: 10.1160/TH11-03-0175. Epub 2011 Jun 9. — View Citation

Stansbury LG, Hess AS, Thompson K, Kramer B, Scalea TM, Hess JR. The clinical significance of platelet counts in the first 24 hours after severe injury. Transfusion. 2013 Apr;53(4):783-9. doi: 10.1111/j.1537-2995.2012.03828.x. Epub 2012 Aug 6. — View Citation

Ware LB, Fang X, Matthay MA. Protein C and thrombomodulin in human acute lung injury. Am J Physiol Lung Cell Mol Physiol. 2003 Sep;285(3):L514-21. doi: 10.1152/ajplung.00442.2002. Epub 2003 May 16. — View Citation

Weyrich AS, Denis MM, Kuhlmann-Eyre JR, Spencer ED, Dixon DA, Marathe GK, McIntyre TM, Zimmerman GA, Prescott SM. Dipyridamole selectively inhibits inflammatory gene expression in platelet-monocyte aggregates. Circulation. 2005 Feb 8;111(5):633-42. doi: 10.1161/01.CIR.0000154607.90506.45. Epub 2005 Jan 24. — View Citation

White NJ, Ward KR, Pati S, Strandenes G, Cap AP. Hemorrhagic blood failure: Oxygen debt, coagulopathy, and endothelial damage. J Trauma Acute Care Surg. 2017 Jun;82(6S Suppl 1):S41-S49. doi: 10.1097/TA.0000000000001436. — View Citation

Wohlauer MV, Moore EE, Thomas S, Sauaia A, Evans E, Harr J, Silliman CC, Ploplis V, Castellino FJ, Walsh M. Early platelet dysfunction: an unrecognized role in the acute coagulopathy of trauma. J Am Coll Surg. 2012 May;214(5):739-46. doi: 10.1016/j.jamcollsurg.2012.01.050. — View Citation

Zipperle J, Altenburger K, Ponschab M, Schlimp CJ, Spittler A, Bahrami S, Redl H, Schochl H. Potential role of platelet-leukocyte aggregation in trauma-induced coagulopathy: Ex vivo findings. J Trauma Acute Care Surg. 2017 May;82(5):921-926. doi: 10.1097/TA.0000000000001410. — View Citation

* Note: There are 53 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	In Vitro Measurement of Endothelial Biomarkers	Plasma biomarkers of endothelial injury will be measured by enzyme-linked immunosorbent assays (von Willebrand factor, syndecan-1, and angiopoietin-2).	0 hour (within 10 minutes of arrival to the Emergency Department)
Primary	In Vitro Measurement Platelet Activation Biomarkers	Cellular biomarkers of platelet activation will be measured by flow cytometry (platelet-monocyte aggregates, integrin aIIbß3, P-selectin, and platelet microparticles).	0 hour (within 10 minutes of arrival to the Emergency Department)
Primary	In Vitro Measurement of Platelet Aggregation	Platelet aggregation will be measured by whole blood multiple electrode impedance aggregometry.	0 hour (within 10 minutes of arrival to the Emergency Department)
Primary	In Vitro Assays of Platelet-Induced Endothelial Permeability	The effect of post-injury platelets on endothelial integrity will be quantified by in vitro assays of platelet-induced endothelial permeability using transendothelial permeability electrical resistance (TEER) assays.	0 hour (within 10 minutes of arrival to the Emergency Department)
Primary	Transfusion products received (red cell, plasma, platelet)	Continuous units of red cell, plasma, platelet; transfused in 24 hours (yes/no); massive transfusion (>10units red cell/24 hour, yes/no)	in first 24 hours after arrival to the emergency department
Primary	Organ Failure	Rates of organ failure (yes/no) (Denver Postinjury Multiple Organ Failure Score)	Within 1 week of arrival to the emergency department
Primary	6-hour Mortality		6 hours after arrival to the emergency department
Primary	24-hour Mortality		24 hours after arrival to the emergency department
Primary	30-days Mortality		30 days after arrival to the emergency department
Primary	Hospital Discharge Mortality		Through hospital discharge (an average of 13 days)