Platelet Reactivity in Septic Shock

Università degli Studi di Ferrara30 enrolled

Overview

Coagulation disorders and thrombocytopenia are common in patients with septic shock. Despite the clinical relevance of sepsis-induced thrombocytopenia, few studies have focused on the prediction of thrombocytopenia in this setting. The aim of this study was to evaluate whether platelets aggregometry and markers of platelets activation, such as mean platelet volume or platelet volume distribution width, could predict sepsis-induced thrombocytopenia in patients with septic shock and normal platelet count on the day of diagnosis.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Septic Shock Thrombocytopenia Sepsis Platelet Aggregation Disseminated Intravascular Coagulation

Interventions

Blood samples were anticoagulated with 0.129 mmol/L of sodium citrate and then centrifugated for 10 min at 200 rpm; platelets aggregation was assessed with an AggRAM Advanced Modular System light transmittance aggregometer (Helena Laboratories, Beaumont, Texas, USA). Low-molecular-weight heparin (LMWH) was given at least 8 hours before any blood aggregation sample. Agonist used to initiate aggregation test were: -Adenosine diphosphate (ADP) to assess P2Y12-dependent platelet aggregation; (20 ng) - Arachidonic acid (AA) to assess cyclooxygenase-dependent platelet Adenosine diphosphate aggregation (1 mcg) - thrombin receptor-activating peptide-6 (TRAP-6) to assess protease-activated receptor 1-dependent platelet aggregation. Max aggregation reached (Aggmax), the slope of the curve (slope) and the latency time (lat) were analyzed for each agonist.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * diagnosis of septic shock * platelet count \>150\*103/mcL. Exclusion Criteria: * age \<18 years * history of any hematologic disorder * chronic liver failure * previous chemotherapy * transfusion of platelet during the previous 4 weeks * renal replacement therapy before ICU admission * history of antiplatelet therapy during the 8 days before inclusion * history of heparin-induced thrombocytopenia (HIT) or other acquired or induced thrombocytopenia * occurrence of HIT (defined as HIT score over 3) * active bleeding

Outcomes

Primary Outcomes

Occurence of sepsis-induced thrombocytopenia

Occurence of platelet count \<150 \*103/μL

Time frame: 5 days after study inclusion

Secondary Outcomes

life-threatening bleeding

Time frame: After 28 days from study inclusion

90-day mortality

Time frame: after 90 days from study enrollment

number of Red blood cells (RBC) packs transfused during ICU stay