A pilot trial of long-distance shipped, extended- and cold-stored platelets in 100% plasma for cardiothoracic surgical bleeding.

Publication Title

Transfusion

Authors

Moritz Stolla
S Lawrence Bailey
Aastha Chauhan
Daire A Byrne
Lucas Ting
Patricia Klotz
Juan N Pulido, Department of Critical Care, Division of Cardiac Anesthesiology, US Anesthesia Partners, Swedish Medical Center, Cherry Hill Campus, Seattle, Washington, USA.Follow
Eric J Lehr, Swedish Medical Center, Swedish Cardiac Surgery, Seattle, Washington, USA.Follow
Samuel J Youssef, Swedish Medical Center, Swedish Cardiac Surgery, Seattle, Washington, USA.Follow
Josh Lawrence
Austin Limanek
Kirsten Alcorn
Patrick Ryan, Swedish Medical Center, Swedish Cardiac Surgery, Seattle, Washington, USA.Follow
David M Stout, Department of Critical Care, Division of Cardiac Anesthesiology, US Anesthesia Partners, Swedish Medical Center, Cherry Hill Campus, Seattle, Washington, USA.Follow

Document Type

Article

Publication Date

3-1-2026

Keywords

Humans; Pilot Projects; Male; Female; Platelet Transfusion; Blood Preservation; Middle Aged; Aged; Double-Blind Method; Blood Platelets; Cardiac Surgical Procedures; Blood Loss, Surgical; Plasma; cardiothoracic surgery; cold‐stored platelets; platelet storage; platelet transfusion.; washington; swedish

Abstract

BACKGROUND: In this pilot trial, we tested the feasibility of conducting a randomized controlled trial in cardiac surgery patients using extended-, 100% plasma-, cold-stored, and long-distance-shipped platelets (CSPs).

STUDY DESIGN AND METHODS: We conducted a single center, controlled, double-blind pilot study in adult patients undergoing elective redo or complex cardiothoracic surgery. Patients were allocated in a week-based block randomization scheme to receive either room temperature-stored platelets (RTPs) or CSPs shipped from a Texas-based blood center and stored between 10 and 14 days. The primary outcome was defined as the feasibility of recruitment and accrual. Several other secondary endpoints were assessed. All platelet units were screened for aggregates using RTP release criteria.

RESULTS: In a post-hoc "as treated" analysis, 15 patients received RTPs, and 9 received CSPs (including 3 who received both). We found that most CSPs (58%) were not usable for transfusion due to the presence of aggregates. This resulted in an excess of subjects receiving RTPs; consequently, the final nine transfused participants were allocated to receive CSPs without randomization. We accrued 0.7 evaluable subjects/month of active enrollment, which was below our desired primary outcome feasibility target of ≥1.2. One death within 28 days occurred in the RTP transfusion group, while none occurred in the CSPs group. In vitro testing yielded contradictory results.

CONCLUSION: Due to slow recruitment and the abundance of aggregates in CSPs, this pilot trial does not support the feasibility of the study protocol.

Area of Special Interest

Cardiovascular (Heart)

Specialty/Research Institute

Cardiology

Specialty/Research Institute

Surgery

Specialty/Research Institute

Pathology & Laboratory Medicine

DOI

10.1111/trf.70076