Cold-stored Platelets for Bleeding Patients: Comment.

Abstract

We read with great interest the recent article published in Anesthesiology by Strandenes et al., titled “A Pilot Trial of Platelets Stored Cold versus at Room Temperature for Complex Cardiothoracic Surgery.”1 We congratulate the authors on their pioneering work in the field of transfusion medicine and efforts to identify methods to prolong the shelf life of platelets and preserve its efficacy.2,3 We have a few comments.First, we were surprised to see that the authors used the clinical assessment, chest tube output, as the primary outcome, because cardiothoracic surgery is an extremely complex procedure that will potentially introduce multiple confounding factors for clinical outcome, such as surgical technique and patient’s baseline characteristics. In this specific study, we noticed a large difference in the logistic Euro-score, the percentage of patients receiving preoperative antiplatelet medication, and the percentage of patients who had previous sternotomy among the three groups, which will all affect the chest tube output and the need for blood transfusion. With a relatively small sample size as a pilot study, the possibility of detecting a difference in clinical outcome is reduced. We are wondering what the rationale was for the authors to choose chest tube output as the primary endpoint instead of a laboratory analytical result?Second, under the safety endpoints, there appears to be a large difference in terms of time to extubation among the three groups. Could the authors kindly provide an explanation for this and the perceived potential impact on patient care?Third, we are wondering if the authors could comment on how the cold stored platelets were transfused? Were they thawed and warmed up to room temperature before transfusion or were they transfused over fluid warmer directly? What was the turnaround time for this practice? Because most intraoperative transfusions are deemed to be urgent in nature, excessive preparation time for blood products should be avoided.Last, we would like the authors to provide more detail on their practice and decision-making in ordering blood products. Because a lot of clinicians would order blood products during the rewarming phase of the cardiopulmonary bypass based on the laboratory results, was there a similar practice at the authors’ institution? This detail in clinical practice could help us to determine if the difference in blood product utilization was actually associated with intervention (transfusion of different types of platelets), or if it was a reflection of empirical practice.Cold stored platelets have been reported to be effective in trauma patients with active bleeding.4,5 No doubt, immediately postoperative patients after cardiothoracic surgery are another major group of patients that can benefit from this practice. We look forward to reading the authors’ future pivotal trial results!Support was provided solely from institutional and/or departmental sources.The authors declare no competing interests.