Evaluation of lyophilized platelets as an infusible hemostatic agent in experimental non-compressible hemorrhage in swine

Authors

  • J. S. HAWKSWORTH,

    1. Combat Casualty Care, Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD
    2. Department of Surgery, Walter Reed Army Medical Center, Washington, DC
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  • E. A. ELSTER,

    1. Combat Casualty Care, Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD
    2. Department of Surgery, National Naval Medical Center, Bethesda, MD
    3. Uniformed Services University of Health Sciences, Bethesda, MD
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  • D. FRYER,

    1. Combat Casualty Care, Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD
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  • F. SHEPPARD,

    1. Department of Surgery, National Naval Medical Center, Bethesda, MD
    2. Uniformed Services University of Health Sciences, Bethesda, MD
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  • V. MORTHOLE,

    1. Department of Comparative Pathology, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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  • G. KRISHNAMURTHY,

    1. Uniformed Services University of Health Sciences, Bethesda, MD
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  • T. TOMORI,

    1. Combat Casualty Care, Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD
    2. Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
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  • T. S. BROWN,

    1. Combat Casualty Care, Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD
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  • D. K. TADAKI

    1. Combat Casualty Care, Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD
    2. Uniformed Services University of Health Sciences, Bethesda, MD
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Douglas Tadaki, Regenerative Medicine Department, Combat Casualty Care, Naval Medical Research Center, Silver Spring, MD 20910, USA.
Tel.: +1 301 319 3223; fax: +1 301 319 7210.
E-mail: doug.tadaki@med.navy.mil

Abstract

Summary. 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.

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