Platelets are critical in stopping hemorrhage as they treat the underlying coagulopathy and improve patient outcomes. However, maintaining an adequate platelet supply is challenging, particularly in austere settings. Thus, additional products such as cold-stored platelets are needed. In this issue, Strandenes et al. describe the completion of a pilot trial that demonstrates the feasibility of conducting a larger randomized controlled trial to assess the safety and efficacy of cold-stored compared to room temperature (standard) platelets in patients undergoing complex cardiothoracic surgery. This pilot trial has an unusual two-stage design. In stage I, 50 adult patients undergoing complex cardiac surgery at high risk of hemorrhage were randomized to receive either cold-stored (n = 25) or standard (n = 25) platelets. Both products were agitated (as standard with room temperature platelets but not required to preserve function in...

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