Estimated reading time: 3 minutes
Refrigerated platelets stored for up to 21 days were as effective at controlling active bleeding during cardiac surgery as conventional platelets stored at room temperature for five to seven days, according to a large randomized clinical trial with implications for platelet availability and waste.
The phase 3 Chilled Platelet Study, or CHIPS, included 1,000 pediatric and adult patients undergoing cardiac surgery with cardiopulmonary bypass at 27 sites in the United States and Australia.
The findings, published in JAMA, showed that cold-stored platelets were noninferior to room-temperature platelets for controlling active surgical bleeding.
Trial Tests Cold-Stored Platelets in 1,000 Patients
Patients in the multicenter trial who required platelet transfusions were randomized 2:1 to receive cold-stored platelets refrigerated at 1°C to 6°C for up to 21 days or conventional platelets stored at room temperature for up to seven days.
Researchers assessed hemostatic efficacy using a five-point score, with higher scores indicating greater bleeding.
Cold-stored platelets had a greater than 99.9% probability of being noninferior to room-temperature platelets across the cold-storage durations studied. Researchers also found no significant difference in 24-hour chest tube output, a secondary measure of postoperative bleeding.
James F. Preuss, MBBS, of The University of Western Australia Medical School and a study co-author, said conventional storage practices developed because room-temperature platelets remain in circulation longer following transfusion.
“Since the 1970s, room-temperature storage has been considered the preferred method because platelets stored this way survive longer in the bloodstream after transfusion,” Preuss said.
Recent research, however, has suggested that cold-stored platelets retain their ability to form blood clots, raising the possibility that refrigeration could extend their useful storage time for treating active bleeding.
Most Safety Outcomes Similar, but Reexploration Was Higher
Researchers found no differences between the groups in venous or arterial thrombotic events, transfusion-associated adverse events, acute respiratory distress syndrome, kidney failure, septic shock or mortality.
However, surgical reexploration rates were higher among patients who received cold-stored platelets.
Warren Pavey, MBBS, of The University of Western Australia Medical School and a study co-author, said the findings support the effectiveness of longer cold storage in this population.
“We found the cold stored platelets to be safe and effective in cardiac surgical bleeding with storage up to 21 days,” Pavey said.
The findings apply specifically to platelets used to treat active bleeding in patients undergoing cardiac surgery with cardiopulmonary bypass. The study did not establish that cold-stored platelets should replace conventional platelets for all transfusion indications.
Why Longer Platelet Storage Matters
The short shelf life of room-temperature platelets creates challenges for blood banks and hospitals trying to maintain adequate supplies without allowing unused units to expire.
Extending storage to 21 days could reduce waste and shortages while making it easier to stock platelets in locations where maintaining a conventional five-to-seven-day inventory is difficult.
“Extending platelet storage could reduce the number of platelets discarded and help maintain a more reliable platelet supply,” Preuss said.
What This Could Mean for Nurses
For nurses working in cardiac surgery, perioperative care, critical care and other settings where blood products are administered, greater platelet availability could eventually improve access to a critical blood product used to manage major surgical bleeding.
The findings do not change current nursing practice. Instead, the trial provides evidence that could inform future decisions about how platelets used for active bleeding are stored and made available, particularly at hospitals where maintaining an adequate supply is challenging.
