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Wound and InjuriesNCT03682757

Post-Injury Platelet Biology: Mechanisms and Outcomes

An observational study of Wound and Injuries and Blood Platelets, run by University of California, San Francisco at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Trauma-induced coagulopathy is a central cause of preventable deaths from hemorrhage after injury. The contribution and impact of altered post injury platelet biology on trauma-induced coagulopathy is not well understood despite the pivotal contribution of platelets to normal coagulation and endothelial integrity. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Wound and Injuries, Blood Platelets, Endothelium
How many people
367 participants
Where
1 siteUnited States
Study dates
20 Sep 2018to 30 Sep 2023
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Study population: Adult patients meeting criteria for full trauma team activation and admitted to Zuckerberg San Francisco General Hospital

Who may be able to join

  • Adult patients meeting criteria for full trauma team activation and admitted to Zuckerberg San Francisco General Hospital.

Who cannot join

  • Patients <18 years old
  • Patients transferred from other hospitals
  • Patients who are pregnant
  • Patients who are incarcerated
  • Patients will be retrospectively excluded if they were taking anticoagulant or anti-platelet medications, have moderate or severe liver disease, or a known bleeding diathesis.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Zuckerberg San Francisco General Hospital

    San Francisco, California, 94110

Other trials in United States

About this study

Trauma-induced coagulopathy is a central cause of preventable deaths from hemorrhage after injury. The contribution and impact of altered post injury platelet biology on trauma-induced coagulopathy is not well understood despite the pivotal contribution of platelets to normal coagulation and endothelial integrity. The central hypothesis for this study is that severe injury and shock drive altered platelet activation, platelet aggregation, and platelet-endothelial interactions that are associated with increased rates of transfusion, organ failure, and mortality. This study will investigate these causal pathways, mechanisms, and associated outcomes in a prospective observational trauma cohort through collection of biospecimens and detailed clinical data.

Read the detailed description

This is a prospective cohort study of trauma patients on admission to the emergency department and for the subsequent 28 days. All adult patients meeting criteria for full trauma team activation and admitted to Zuckerberg San Francisco General Hospital and Trauma center, a level-1 trauma center, are eligible for enrollment. A 20-ml sample of blood will be drawn within 10 minutes of arrival in the emergency department (ED), processed in the central laboratory, and plasma stored at -80°C. Blood samples will be collected immediately on presentation via initial placement of a 16-gauge or larger peripheral intravenous line. Plasma biomarkers of endothelial injury will be measured by enzyme-linked immunosorbent assays (von Willebrand factor, syndecan-1, and angiopoietin-2). Cellular biomarkers of platelet activation will be measured by flow cytometry (platelet-monocyte aggregates, integrin αIIbβ3, P-selectin, and platelet microparticles). Platelet aggregation will be measured by whole blood multiple electrode impedance aggregometry. The effect of post-injury platelets on endothelial integrity will be quantified by in vitro assays of platelet-induced endothelial permeability. Comprehensive demographic data and medical history will be collected from chart review, interviews of patients and family members. Detailed clinical and outcome data is collected including transfusion timing and doses, the incidence of organ failure (Denver Postinjury Multiple Organ Failure Score), acute respiratory distress syndrome (Berlin Definition), infection, symptomatic thromboembolic complications, ventilator-free days, length of intensive care unit (ICU) and hospital stay, and mortality (6 hours, 24 hours, 30 days). In hospital mortality after 30 days will be assessed for all patients. Standard coagulation measures (international normalized ratio, prothrombin time, platelet count) and other laboratory measures will be collected to account and control for other distinct but highly integrated pathways implicated in trauma-induced coagulopathy. The Trauma Registry, a large database managed under guidelines from the American Trauma society, uses chart review to retrospectively assign Injury Severity Scores (ISS) and Abbreviated Injury Scores (AIS).

Keywords
Trauma, Platelets, Coagulopathy
Medical subject headings
Wounds and Injuries, Hemostatic Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

Study groups in NCT03682757
Study groupRoleWhat they receive
Severe Injury/ShockSeverely injured trauma patients presenting with shock, as defined by an Injury Severity Score (ISS)>=25, and base deficit (BD)>=6.
Without Severe Injury/ShockNot severely injured trauma patients presenting without shock, as defined by an Injury Severity Score (ISS)<25, and base deficit (BD) <6.
Healthy ControlsUninjured healthy volunteers

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. In Vitro Measurement of Endothelial Biomarkers

    Plasma biomarkers of endothelial injury will be measured by enzyme-linked immunosorbent assays (von Willebrand factor, syndecan-1, and angiopoietin-2).

    Measured: 0 hour (within 10 minutes of arrival to the Emergency Department)

  2. In Vitro Measurement Platelet Activation Biomarkers

    Cellular biomarkers of platelet activation will be measured by flow cytometry (platelet-monocyte aggregates, integrin αIIbβ3, P-selectin, and platelet microparticles).

    Measured: 0 hour (within 10 minutes of arrival to the Emergency Department)

  3. In Vitro Measurement of Platelet Aggregation

    Platelet aggregation will be measured by whole blood multiple electrode impedance aggregometry.

    Measured: 0 hour (within 10 minutes of arrival to the Emergency Department)

  4. In Vitro Assays of Platelet-Induced Endothelial Permeability

    The effect of post-injury platelets on endothelial integrity will be quantified by in vitro assays of platelet-induced endothelial permeability using transendothelial permeability electrical resistance (TEER) assays.

    Measured: 0 hour (within 10 minutes of arrival to the Emergency Department)

  5. Transfusion products received (red cell, plasma, platelet)

    Continuous units of red cell, plasma, platelet; transfused in 24 hours (yes/no); massive transfusion (>10units red cell/24 hour, yes/no)

    Measured: in first 24 hours after arrival to the emergency department

  6. Organ Failure

    Rates of organ failure (yes/no) (Denver Postinjury Multiple Organ Failure Score)

    Measured: Within 1 week of arrival to the emergency department

  7. 6-hour Mortality

    Measured: 6 hours after arrival to the emergency department

  8. 24-hour Mortality

    Measured: 24 hours after arrival to the emergency department

  9. 30-days Mortality

    Measured: 30 days after arrival to the emergency department

  10. Hospital Discharge Mortality

    Measured: Through hospital discharge (an average of 13 days)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted25 Sep 2018
  2. Study start20 Sep 2018
  3. Primary completion30 Sep 2023
  4. Study completion30 Sep 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
367 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03682757
Sponsor's protocol ID
P0528296
Other IDs
5K23GM130892
Status last verified
Dec 2023
First submitted
17 Sep 2018
Last updated
8 Dec 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Norton R, Kobusingye O. Injuries. N Engl J Med. 2013 May 2;368(18):1723-30. doi: 10.1056/NEJMra1109343. No abstract available.

    PubMed 23635052
  • Cannon JW. Hemorrhagic Shock. N Engl J Med. 2018 Jan 25;378(4):370-379. doi: 10.1056/NEJMra1705649. No abstract available.

    PubMed 29365303
  • Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma. 2006 Jun;60(6 Suppl):S3-11. doi: 10.1097/01.ta.0000199961.02677.19.

    PubMed 16763478
  • Cohen MJ, Christie SA. New understandings of post injury coagulation and resuscitation. Int J Surg. 2016 Sep;33(Pt B):242-245. doi: 10.1016/j.ijsu.2016.05.037. Epub 2016 May 19.

    PubMed 27212591
  • Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma. 2003 Jun;54(6):1127-30. doi: 10.1097/01.TA.0000069184.82147.06.

    PubMed 12813333
  • MacLeod JB, Lynn M, McKenney MG, Cohn SM, Murtha M. Early coagulopathy predicts mortality in trauma. J Trauma. 2003 Jul;55(1):39-44. doi: 10.1097/01.TA.0000075338.21177.EF.

    PubMed 12855879
  • Baimukanova G, Miyazawa B, Potter DR, Gibb SL, Keating S, Danesh A, Beyer A, Dayter Y, Bruhn R, Muench MO, Cap AP, Norris PJ, Spinella P, Cohen M, Pati S. The effects of 22 degrees C and 4 degrees C storage of platelets on vascular endothelial integrity and function. Transfusion. 2016 Mar;56 Suppl 1:S52-64. doi: 10.1111/trf.13455.

    PubMed 27001362
  • Baimukanova G, Miyazawa B, Potter DR, Muench MO, Bruhn R, Gibb SL, Spinella PC, Cap AP, Cohen MJ, Pati S. Platelets regulate vascular endothelial stability: assessing the storage lesion and donor variability of apheresis platelets. Transfusion. 2016 Mar;56 Suppl 1(Suppl 1):S65-75. doi: 10.1111/trf.13532.

    PubMed 27001364
  • Kutcher ME, Redick BJ, McCreery RC, Crane IM, Greenberg MD, Cachola LM, Nelson MF, Cohen MJ. Characterization of platelet dysfunction after trauma. J Trauma Acute Care Surg. 2012 Jul;73(1):13-9. doi: 10.1097/TA.0b013e318256deab.

    PubMed 22743367
  • Davenport RA, Brohi K. Coagulopathy in trauma patients: importance of thrombocyte function? Curr Opin Anaesthesiol. 2009 Apr;22(2):261-6. doi: 10.1097/ACO.0b013e328325a6d9.

    PubMed 19390252
  • Brown LM, Call MS, Margaret Knudson M, Cohen MJ; Trauma Outcomes Group; Holcomb JB, Wade CE, Brasel KJ, Vercruysse G, MacLeod J, Dutton RP, Hess JR, Duchesne JC, McSwain NE, Muskat P, Johannigamn J, Cryer HM, Tillou A, Pittet JF, De Moya MA, Schreiber MA, Tieu B, Brundage S, Napolitano LM, Brunsvold M, Brunsvold M, Beilman G, Peitzman AB, Zenait MS, Sperry J, Alarcon L, Croce MA, Minei JP, Kozar R, Gonzalez EA, Stewart RM, Cohn SM, Mickalek JE, Bulger EM, Cotton BA, Nunez TC, Ivatury R, Meredith JW, Miller P, Pomper GJ, Marin B. A normal platelet count may not be enough: the impact of admission platelet count on mortality and transfusion in severely injured trauma patients. J Trauma. 2011 Aug;71(2 Suppl 3):S337-42. doi: 10.1097/TA.0b013e318227f67c.

    PubMed 21814101
  • Kornblith LZ, Kutcher ME, Redick BJ, Calfee CS, Vilardi RF, Cohen MJ. Fibrinogen and platelet contributions to clot formation: implications for trauma resuscitation and thromboprophylaxis. J Trauma Acute Care Surg. 2014 Feb;76(2):255-6; discussion 262-3. doi: 10.1097/TA.0000000000000108.

    PubMed 24458031
  • Li R, Elmongy H, Sims C, Diamond SL. Ex vivo recapitulation of trauma-induced coagulopathy and preliminary assessment of trauma patient platelet function under flow using microfluidic technology. J Trauma Acute Care Surg. 2016 Mar;80(3):440-9. doi: 10.1097/TA.0000000000000915.

    PubMed 27082706
  • Wohlauer MV, Moore EE, Thomas S, Sauaia A, Evans E, Harr J, Silliman CC, Ploplis V, Castellino FJ, Walsh M. Early platelet dysfunction: an unrecognized role in the acute coagulopathy of trauma. J Am Coll Surg. 2012 May;214(5):739-46. doi: 10.1016/j.jamcollsurg.2012.01.050.

    PubMed 22520693
  • Jacoby RC, Owings JT, Holmes J, Battistella FD, Gosselin RC, Paglieroni TG. Platelet activation and function after trauma. J Trauma. 2001 Oct;51(4):639-47. doi: 10.1097/00005373-200110000-00003.

    PubMed 11586152

Questions about this trial

What is this clinical trial studying?

An observational study of Wound and Injuries and Blood Platelets, run by University of California, San Francisco at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 8 Dec 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

In Vitro Measurement of Endothelial Biomarkers (time frame: 0 hour (within 10 minutes of arrival to the Emergency Department)). The study lists 10 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03682757, which also lists 53 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Dec 2023.

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