{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T17:40:23Z","timestamp":1792086023934,"version":"4.4.0"},"reference-count":28,"publisher":"American Medical Association (AMA)","issue":"14","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2026,10,13]]},"abstract":"\n Importance<\/jats:title>\n Patients undergoing cardiac surgery with cardiopulmonary bypass often require platelet transfusions for bleeding. Platelets are routinely stored at room temperature (20-24 \u00b0C) for up to 5 to 7 days; however, cold storage (1-6 \u00b0C) may allow for increased storage duration without loss of hemostatic function.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine the maximum cold-storage duration, up to 21 days, for which cold-stored platelets (CSPs) are noninferior or superior in hemostatic efficacy to room-temperature platelets (RTPs) when transfused in actively bleeding patients undergoing cardiac surgery with cardiopulmonary bypass.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n A phase 3, multicenter, randomized, partially blinded, adaptive, noninferiority, storage duration\u2013ranging trial conducted in pediatric and adult patients undergoing cardiac surgery with planned cardiopulmonary bypass at 27 sites in the US and Australia from December 2021 to March 2025. Statistical analysis was conducted from September 9 to October 3, 2025.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Patients were randomized 2:1 to receive CSPs with a maximum of 21 days of storage vs RTPs with a maximum of 7 days of storage.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was a hemostatic efficacy score with values ranging from 1 to 5 and higher values indicating greater bleeding. The noninferiority margin was 1 point. The success criterion was met if at least 1 cold-storage duration of 7 days or more had a posterior probability of noninferiority of at least 97.5%. The secondary outcome was 24-hour chest tube output.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of the 1000 patients who underwent platelet transfusion, 989 were included in the primary analysis (650 CSPs and 339 RTPs). The cohort had a mean (SD) age of 42.1 (30.1) years and 67.8% were male. CSPs were noninferior to RTPs for the primary outcome, with a probability of greater than 99.9% for all cold-storage durations. Pooled across storage durations, CSPs had a mean difference from RTPs of 0.09 (95% credible interval, \u22120.06 to 0.23). Median (IQR) chest tube output at 24 hours (8.9 mL\/kg [5.2-15.4] for CSPs vs 8.4 mL\/kg [5.5-15.9] for RTPs; difference in medians, 0.4 [95% CI, \u22121.0 to 1.5]) was not statistically different between study groups. In a post hoc analysis, as all storage durations were noninferior, considering the CSPs as a single group, the hemostatic efficacy score was similar between both groups: mean (SD) of 3.08 (1.15) CSPs vs 2.99 (1.10) RTPs. There were no differences in venous or arterial thrombotic events, transfusion-associated adverse events, acute respiratory distress syndrome, kidney failure, septic shock, and mortality between the study groups, except for increased reexploration rates in the CSP group.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n For patients undergoing cardiac surgery, CSPs stored up to 21 days are noninferior to RTPs for the control of active surgical bleeding. Use of CSPs may allow for increased availability of platelets by reducing wastage and shortages and may allow for incorporation of platelets into inventory at locations where platelets cannot be maintained due to the 5- to 7-day shelf life of RTPs.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT04834414<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2026.13328","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:30:26Z","timestamp":1786980626000},"page":"1216","source":"Crossref","is-referenced-by-count":3,"title":["Cold and Room-Temperature Platelets in Cardiac Surgery"],"prefix":"10.1001","volume":"336","author":[{"given":"Philip C.","family":"Spinella","sequence":"first","affiliation":[{"name":"Departments of Surgery and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole D.","family":"Zantek","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, Division of Transfusion Medicine, University of Minnesota, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"VanBuren","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Critical Care, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan C.","family":"Nicolson","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Division of Cardiothoracic Anesthesiology, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish K.","family":"Khanna","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Division of Critical Care Medicine, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina"},{"name":"Outcomes Research Consortium, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan M.","family":"Klompas","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology & Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael L.","family":"Boisen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany M.","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology & Perioperative Medicine, Division of Cardiothoracic Anesthesiology, UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Monteleone","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalia A.","family":"Bashir","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Critical Care Medicine, Texas Children\u2019s Hospital, Baylor College of Medicine, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warren","family":"Pavey","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Perioperative Medicine, Division of Cardiothoracic Anaesthesia, Fiona Stanley Hospital, Perth, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradford B.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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