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

Justin Lu; Keyvan Karkouti; Miki Peer; Marina Englesakis; Philip C Spinella; Torunn O Apelseth; Thomas G Scorer; Walter H A Kahr; Mark McVey; Vivek Rao; Lusine Abrahamyan; Lani Lieberman; Holly Mewhort; Dana V Devine; Jeannie Callum; Justyna Bartoszko

doi:10.1007/s12630-023-02561-9

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

Can J Anaesth. 2023 Oct;70(10):1682-1700. doi: 10.1007/s12630-023-02561-9. Epub 2023 Oct 13.

Authors

Justin Lu¹, Keyvan Karkouti^{2

3

4

5}, Miki Peer², Marina Englesakis⁶, Philip C Spinella^{7

8}, Torunn O Apelseth^{9

10}, Thomas G Scorer^{11

12}, Walter H A Kahr^{13

14

15}, Mark McVey^{3

16

17}, Vivek Rao¹⁸, Lusine Abrahamyan^{19

20}, Lani Lieberman²¹, Holly Mewhort²², Dana V Devine^{23

24}, Jeannie Callum^{25

26

27}, Justyna Bartoszko^{28

29

30}

Affiliations

¹ Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
² Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto General Hospital, Toronto, ON, Canada.
³ Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
⁴ Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.
⁵ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
⁶ Library & Information Services, University Health Network, Toronto, ON, Canada.
⁷ Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁸ Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
⁹ Department of Immunology and Transfusion Medicine, Haukeland University Hospital, University of Bergen, Bergen, Norway.
¹⁰ Norwegian Armed Forces Joint Medical Services, Norwegian Armed Forces, Oslo, Norway.
¹¹ Centre of Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK.
¹² School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK.
¹³ Division of Haematology/Oncology, The Hospital for Sick Children (SickKids), Toronto, ON, Canada.
¹⁴ Cell Biology Program, SickKids Research Institute, Toronto, ON, Canada.
¹⁵ Departments of Paediatrics and Biochemistry, University of Toronto, Toronto, ON, Canada.
¹⁶ Department of Anesthesia and Pain Medicine, The Hospital for Sick Children (SickKids), Toronto, ON, Canada.
¹⁷ Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada.
¹⁸ Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
¹⁹ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
²⁰ Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Research Institute, Toronto, ON, Canada.
²¹ Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
²² Department of Surgery, School of Medicine, Queen's University, Kingston, ON, Canada.
²³ Canadian Blood Services, Vancouver, BC, Canada.
²⁴ Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, BC, Canada.
²⁵ Quality in Utilization, Education and Safety in Transfusion Research Program, University of Toronto, Toronto, ON, Canada.
²⁶ Department of Pathology and Molecular Medicine, School of Medicine, Queen's University, Kingston, ON, Canada.
²⁷ Kingston Health Sciences Centre, Kingston General Hospital, Kingston, ON, Canada.
²⁸ Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada. justyna.bartoszko@uhn.ca.
²⁹ Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada. justyna.bartoszko@uhn.ca.
³⁰ 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@uhn.ca.

PMID: 37831350
DOI: 10.1007/s12630-023-02561-9

Abstract
in English, French

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.

Keywords: cold-preserved; hemostasis; platelet additive solutions; platelets; storage lesions.

Publication types

Review

MeSH terms

Adult
Blood Platelets / metabolism
Blood Preservation
Cardiac Surgical Procedures*
Cold Temperature
Hemorrhage
Hemostatics* / metabolism
Humans

Substances

Hemostatics

Abstract in English, French

Publication types

MeSH terms

Substances

Abstract
in English, French