ArticleThe journal of trauma and acute care surgery2020
Dynamic effects of calcium on in vivo and ex vivo platelet behavior after trauma.
Article in The journal of trauma and acute care surgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
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Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it, 40 citations in OpenAlex.
- Hypocalcaemia upon arrival (HUA) in trauma patients who did and did not receive prehospital blood products: a systematic review and meta-analysis.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2024Pooled it
- The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition.Critical care (London, England) · 2023Guideline
- Association Between Preoperative Calcium Levels and the Occurrence of Postoperative PE in Trauma Patients: A Retrospective Multicenter Cohort Study.World journal of surgery · 2026Article
- Differential Regulation of Granule Release in Platelets and Immune Cells.TH open : companion journal to thrombosis and haemostasis · 2026Article
- Correlates of incident hypocalcemia amongst trauma patients in the Western Cape of South Africa: a secondary analysis of the Epidemiology and Outcomes of Prolonged Trauma Care (EpiC) study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Article
- Hypocalcemia associated with adverse outcomes following severe traumatic injury in the Western Cape of South Africa: a secondary analysis of multicenter data from the Epidemiology and Outcomes of Prolonged Trauma Care (EpiC) study.International journal of emergency medicine · 2025Article
- Ten Machine Learning Models for Predicting Preoperative and Postoperative Coagulopathy in Patients With Trauma: Multicenter Cohort Study.Journal of medical Internet research · 2025Article
- Calcium supplementation during trauma resuscitation: a propensity score-matched analysis from the TraumaRegister DGUCritical care (London, England) · 2024Article
- Article
- Trauma-induced disturbances in ionized calcium levels correlate parabolically with coagulopathy, transfusion, and mortality: a multicentre cohort analysis from the TraumaRegister DGUCritical care (London, England) · 2023Article
- Hemorrhagic shock and tissue injury provoke distinct components of trauma-induced coagulopathy in a swine model.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2023Article
- Platelet Hemostasis Reactions at Different Temperatures Correlate with Intracellular Calcium Concentration.International journal of molecular sciences · 2022Article
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
Abstract
backgroundMobilization of intra and extracellular calcium is required for platelet activation, aggregation, and degranulation. However, the importance of alterations in the calcium-platelet axis after injury is unknown. We hypothesized that in injured patients, in vivo initial calcium concentrations (pretransfusion) predict ex vivo platelet activation and aggregation, viscoelastic clot strength, and transfusion of blood products. We additionally hypothesized that increasing calcium concentrations ex vivo increases the expression of platelet activation surface receptors and platelet aggregation responses to agonist stimulation in healthy donor blood.
methodsBlood samples were collected from 538 trauma patients on arrival to the emergency department. Standard assays (including calcium), platelet aggregometry (PA) and thromboelastometry (ROTEM) were performed. In PA, platelet activation (prestimulation impedance [Ω]) and aggregation responses to agonist stimulation (area under the aggregation curve [AUC]) with adenosine diphosphate (ADP), thrombin receptor-activating peptide, arachidonic acid (AA), and collagen (COL) were measured. Multivariable regression tested the associations of calcium with PA, ROTEM, and transfusions. To further examine the calcium-platelet axis, calcium was titrated in healthy blood. Platelet aggregometry and ROTEM were performed, and expression of platelet glycoprotein IIb/IIIa and P-selectin was measured by flow cytometry.
resultsThe patients were moderately injured with normal calcium and platelet counts. Higher calcium on arrival (pretransfusion) was independently associated with increased platelet activation (prestimulation, Ω; p < 0.001), aggregation (ADP-stimulated, AUC; p = 0.002; thrombin receptor-activating peptide-stimulated, AUC; p = 0.038), and clot strength (ROTEM max clot firmness; p < 0.001), and inversely associated with 24-hour transfusions of blood, plasma, and platelets (all p < 0.005). Up-titrating calcium in healthy blood increased platelet activation (prestimulation, Ω; p < 0.001), aggregation (ADP, AA, COL-stimulated AUCs; p < 0.050), and expression of P-selectin (p = 0.003).
conclusionInitial calcium concentrations (pretransfusion) are independently associated with platelet activation, aggregation, clot-strength, and transfusions after injury. These changes may be mediated by calcium driven expression of surface receptors necessary for platelet activation and aggregation. However, the therapeutic benefit of early, empiric calcium repletion in trauma patients remains undefined. LEVEL OF EVIDENCE: Prognostic, level V.
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