From the Guidelines
Elevated platelet counts after fractures do not typically require treatment, as they are a normal part of the healing response, but it is crucial to maintain a platelet count above 50 × 10^9/l to prevent bleeding complications, as recommended by the European guideline 1. The normal healing response after a fracture often involves a reactive thrombocytosis, which usually begins 3-5 days after injury, peaks at 2-3 weeks, and resolves within 4-6 weeks. Some key points to consider in the management of elevated platelet counts after fractures include:
- Maintaining a platelet count above 50 × 10^9/l to prevent bleeding complications, with a suggested initial dose of four to eight platelet concentrates or one aphaeresis pack 1
- Considering a higher target level of 100 × 10^9/l for patients with multiple trauma, brain injury, and massive bleeding, as suggested by expert consensus 1
- Monitoring platelet counts and adjusting treatment as needed to prevent bleeding complications and promote healing
- Being aware that the role of platelets in the development of traumatic coagulopathy is not fully understood, and that there is weak scientific evidence to support a particular platelet transfusion threshold in trauma patients 1 The European guideline recommends maintaining a platelet count above 50 × 10^9/l, with a higher target level of 100 × 10^9/l suggested for patients with multiple trauma, brain injury, and massive bleeding 1.
From the Research
Elevated Platelets after Fractures
- Elevated platelets after fractures can be associated with an increased risk of thrombotic events 2, 3.
- Studies have shown that platelet activation and function are altered after trauma, with increased platelet activation parameters and decreased platelet function in some cases 2.
- The use of aspirin or low-molecular-weight heparin for thromboprophylaxis after fractures has been studied, with some trials suggesting that aspirin is noninferior to low-molecular-weight heparin in preventing death and venous thromboembolism 4, 5, 6.
- Platelet behavior after major trauma can be altered, with impaired ex vivo agonist responsiveness in the acute post-injury phase and hyper-responsive platelets in patients surviving the initial insult 3.
- The alterations in platelet behavior after trauma can have implications for secondary organ injury and multiple-organ dysfunction syndromes, and may be associated with increased mortality risk 2, 3.
Thromboprophylaxis after Fractures
- Aspirin and low-molecular-weight heparin are commonly used for thromboprophylaxis after fractures, with studies suggesting that aspirin may be a viable alternative to low-molecular-weight heparin in some cases 4, 5, 6.
- The choice of thromboprophylaxis agent may depend on individual patient factors, such as the risk of bleeding complications and the presence of other medical conditions 4, 5, 6.
- Further research is needed to fully understand the optimal thromboprophylaxis strategy after fractures, including the role of aspirin and low-molecular-weight heparin 4, 5, 6.
Platelet Activation and Function after Trauma
- Platelet activation and function are altered after trauma, with increased platelet activation parameters and decreased platelet function in some cases 2, 3.
- The alterations in platelet behavior after trauma can have implications for secondary organ injury and multiple-organ dysfunction syndromes, and may be associated with increased mortality risk 2, 3.
- Further research is needed to fully understand the mechanisms underlying the alterations in platelet behavior after trauma, and to develop effective therapies to modulate platelet function in this setting 3.