• Justin Lu, Keyvan Karkouti, Miki Peer, Marina Englesakis, Philip C Spinella, Torunn O Apelseth, Thomas G Scorer, KahrWalter H AWHADivision of Haematology/Oncology, The Hospital for Sick Children (SickKids), Toronto, ON, Canada.Cell Biology Program, SickKids Research Institute, Toronto, ON, Canada.Departments of Paediatrics and Biochemistry, University of Toronto, To, Mark McVey, Vivek Rao, Lusine Abrahamyan, Lani Lieberman, Holly Mewhort, Dana V Devine, Jeannie Callum, and Justyna Bartoszko.
• Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
• Can J Anaesth. 2023 Oct 1; 70 (10): 168217001682-1700.

PurposeCold-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.SourceA 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 FindingsWhen 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.ConclusionCold-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.© 2023. Canadian Anesthesiologists' Society.

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