创伤相关性静脉血栓栓塞症中的血小板通量：创伤性血栓栓塞症研究领导者联盟（CLOTT）研究的二次分析
Platelet flux in trauma-associated venous thromboembolism: A secondary analysis of the Consortium of Leaders in the Study of Traumatic Thromboembolism (CLOTT) studies.
作者信息
Andraska Elizabeth, Fields Alexander, Nunez-Garcia Brenda, Moore Ernest, Wade Charles E, Knudson M Margaret, Neal Matthew D, Kornblith Lucy
机构信息
From the University of Pittsburgh, Pittsburgh Trauma and Transfusion Medicine Research Center (E.A., M.D.N.), University of California, San Francisco and Zuckerberg San Francisco General Hospital (B.N.-G., A.F., M.M.K, L.K.), Ernest E Moore Shock Trauma Center at Denver Health (E.M.), University of Texas Health Sciences Center, Houston (C.E.W.).
出版信息
J Trauma Acute Care Surg. 2025 Jun 1;98(6):957-965. doi: 10.1097/TA.0000000000004592. Epub 2025 Mar 20.
BACKGROUND
Venous thromboembolism (VTE) after traumatic injury is morbid. Evaluating changes in platelets in injured patients who develop VTE could identify platelet-based strategies for management of thrombotic complications after injury.
METHODS
In a prospectively designed secondary analysis of a multicenter cohort study conducted by the Consortium of Leaders in the Study of Traumatic Thromboembolism (CLOTT1) study group, injured patients aged 18 to 40 years admitted for a minimum of 48 hours with at least one risk factor for VTE were evaluated. A subset of CLOTT1 patients had platelet aggregometry and thromboelastography performed to examine platelet function (CLOTT2). Patients who developed VTE were compared with those who did not.
RESULTS
Of 7,805 patients from CLOTT1 (mean [SD] age, 29.1 [6.4] years; 1,987 [25.5%] female), 425 (5.4%) developed VTE. Platelet count was lower at each time point for patients with VTE (admission: 242 [234-251] vs. 254 [252-256], p < 0.01; hospital day 1: 157 [150-164] vs. 197 [195-198], p < 0.01; all counts ×10 9 /L). An initial 10-point reduction in platelet count was associated with development of VTE (odds ratio, 1.32 [1.13-1.53]; p < 0.01) controlling for shock, injury severity, coagulopathy, sex, and product transfusion. When evaluating 129 CLOTT2 patients, velocity of platelet aggregation was higher on admission in the VTE group (18.5 vs. 12.8 aggregation units/min; p < 0.01) in response to adenosine diphosphate stimulation. In response to thrombin stimulation, velocity of platelet aggregation was higher at 48 hours (34.4 vs. 12.3 aggregation units/min; p < 0.01), and overall aggregation was higher in the VTE group at 72 hours (area under the curve, 173.2 vs. 129.6; p < 0.01). Thromboelastography results were not different between groups.
CONCLUSION
This study identified an association of early reduction in platelet count with the development of VTE in injured patients at risk for VTE. P2Y 1/2 and protease-activated receptor 1 receptor stimulation changes in platelet aggregation responses are altered in VTE patients. Interrogating platelet count and functional responses may be beneficial in evaluating thrombotic complications after injury.
LEVEL OF EVIDENCE
Diagnostic Test/Criteria; Level III.
背景
创伤后静脉血栓栓塞症（VTE）具有较高的发病率。评估发生VTE的创伤患者血小板的变化，有助于确定基于血小板的创伤后血栓形成并发症管理策略。
方法
在创伤性血栓栓塞研究联盟（CLOTT1）研究小组进行的一项前瞻性多中心队列研究的二次分析中，对年龄在18至40岁、因创伤入院至少48小时且至少有一个VTE危险因素的患者进行评估。CLOTT1研究中的一部分患者进行了血小板聚集试验和血栓弹力图检查以评估血小板功能（CLOTT2）。将发生VTE的患者与未发生VTE的患者进行比较。
结果
CLOTT1研究中的7805例患者（平均[标准差]年龄为29.1[6.4]岁；1987例[25.5%]为女性），425例（5.4%）发生了VTE。VTE患者在各个时间点的血小板计数均较低（入院时：242[234 - 251]×10⁹/L vs. 254[252 - 256]×10⁹/L，p < 0.01；住院第1天：157[150 - 164]×10⁹/L vs. 197[195 - 198]×10⁹/L，p < 0.01）。在校正休克、损伤严重程度、凝血病、性别和血制品输注后，血小板计数初始下降10个单位与VTE的发生相关（比值比，1.32[1.13 - 1.53]；p < 0.01）。在评估129例CLOTT2患者时，VTE组在入院时对二磷酸腺苷刺激的血小板聚集速度较高（18.5对12.8聚集单位/分钟；p < 0.01）。在凝血酶刺激下，VTE组在48小时时血小板聚集速度较高（34.4对12.3聚集单位/分钟；p < 0.01），且在72小时时VTE组的总体聚集程度较高（曲线下面积，173.2对129.6；p < 0.01）。两组间血栓弹力图结果无差异。
结论
本研究发现，有VTE风险的创伤患者早期血小板计数降低与VTE的发生有关。VTE患者中P2Y1/2和蛋白酶激活受体1受体刺激引起的血小板聚集反应发生改变。检测血小板计数和功能反应可能有助于评估创伤后血栓形成并发症。
证据水平
诊断试验/标准；三级。
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