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Updated: Jul 13, 2025
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Cold-stored platelets for acute bleeding in cardiac surgical patients: a narrative review
Justin Lu1, Keyvan Karkouti2,3,4,5, Miki Peer2
1Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Insights
Cold-stored platelets (CSP) show enhanced hemostatic properties and longer shelf-life compared to room-temperature platelets (RTP). Further clinical trials are needed to confirm their benefits in cardiac surgery patients.
Area of Science:
- Transfusion Medicine
- Hematology
- Surgical Hemostasis
Background:
- Standard room-temperature platelets (RTP) are stored at 20-24°C.
- Cold-stored platelets (CSP) are stored at 1-6°C, an area of active research.
- Emerging evidence suggests CSP possess superior hemostatic capabilities over RTP.
Purpose of the Study:
- To review the application of CSP in adult cardiac surgery.
- To summarize preclinical and clinical evidence supporting CSP use.
- To highlight recent advancements in CSP research.
Main Methods:
- A comprehensive literature search was performed using MEDLINE and other databases up to February 2022.
- Searches included terms related to cardiac surgery, blood, platelets, and cold storage.
- Trial registries were searched, and references of included articles were hand-searched for relevant studies on adult surgical patients and CSP outcomes.
Main Results:
- Cold storage at 1-6°C slows platelet metabolism, preserving hemostatic function and extending storage duration.
- CSP exhibit superior adhesion under physiologic shear conditions and comparable or enhanced aggregation responses.
- Structural, metabolic, and molecular changes in CSP appear to enhance their hemostatic activity, with preliminary clinical data supporting further investigation.
Conclusions:
- CSP offer potential advantages over RTP, including enhanced hemostatic capacity, extended shelf-life, and reduced bacterial contamination risk.
- While promising, large-scale clinical trials are essential to validate the role of CSP in managing acute bleeding, particularly in cardiac surgery.
- CSP may represent a significant advancement in platelet transfusion therapy.
Purpose:
Cold-stored platelets (CSP) are an increasingly active topic of international research. They are maintained at 1-6 °C, in contrast to standard room-temperature platelets (RTP) kept at 20-24 °C. Recent evidence suggests that CSP have superior hemostatic properties compared with RTP. This narrative review explores the application of CSP in adult cardiac surgery, summarizes the preclinical and clinical evidence for their use, and highlights recent research.
Source:
A targeted search of MEDLINE and other databases up to 24 February 2022 was conducted. Search terms combined concepts such as cardiac surgery, blood, platelet, and cold-stored. Searches of trial registries ClinicalTrials.gov and WHO International Clinical Trials Registry Platform were included. Articles were included if they described adult surgical patients as their population of interest and an association between CSP and clinical outcomes. References of included articles were hand searched.
Principal Findings:
When platelets are stored at 1-6 °C, their metabolic rate is slowed, preserving hemostatic function for increased storage duration. Cold-stored platelets have superior adhesion characteristics under physiologic shear conditions, and similar or superior aggregation responses to physiologic agonists. Cold-stored platelets undergo structural, metabolic, and molecular changes which appear to "prime" them for hemostatic activity. While preliminary, clinical evidence supports the conduct of trials comparing CSP with RTP for patients with platelet-related bleeding, such as those undergoing cardiac surgery.
Conclusion:
Cold-stored platelets may have several advantages over RTP, including increased hemostatic capacity, extended shelf-life, and reduced risk of bacterial contamination. Large clinical trials are needed to establish their potential role in the treatment of acutely bleeding patients.
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