Antiplatelet therapy is associated with decreased transfusion-associated risk of lung dysfunction, multiple organ failure, and mortality in trauma patients.

Antiplatelet therapy is associated with decreased transfusion-associated risk of lung dysfunction, multiple organ failure, and mortality in trauma patients.

MedLine Citation:	PMID: 23263579 Owner: NLM Status: MEDLINE
Abstract/OtherAbstract:	OBJECTIVE: To determine whether prehospital antiplatelet therapy was associated with reduced incidence of acute lung dysfunction, multiple organ failure, and mortality in blunt trauma patients. DESIGN: Secondary analysis of a cohort enrolled in the National Institute of General Medical Sciences Trauma Glue Grant database. SETTING: Multicenter study including nine U.S. level-1 trauma centers. PATIENTS: A total of 839 severely injured blunt trauma patients at risk for multiple organ failure (age > 45 yr, base deficit > 6 mEq/L or systolic blood pressure < 90 mm Hg, who received a blood transfusion). Severe/isolated head injuries were excluded. MEASUREMENTS AND MAIN RESULTS: Primary outcomes were lung dysfunction (defined as grades 2-3 by the Denver multiple organ failure score), multiple organ failure (Denver multiple organ failure score >3), and mortality. Patients were documented as on antiplatelet therapy if taking acetylsalicylic acid, clopidogrel, and/or ticlopidine. Fifteen percent were taking antiplatelet therapy prior to injury. Median injury severity score was 30 (interquartile range 22-51), mean age 61 + 0.4 yr and median RBCs volume transfused was 1700 mL (interquartile range 800-3150 mL). Overall, 63% developed lung dysfunction, 19% had multiple organ failure, and 21% died. After adjustment for age, gender, comorbidities, blood products, crystalloid/12 hrs, presence of any head injury, injury severity score, and 12 hrs base deficit > 8 mEq/L, 12 hrs RBC transfusion was associated with a significantly smaller risk of lung dysfunction and multiple organ failure among the group receiving antiplatelet therapy compared with those not receiving it (lung dysfunction p = 0.0116, multiple organ failure p = 0.0291). In addition, antiplatelet therapy had a smaller risk (albeit not significant, p = 0.06) of death for patients receiving RBC compared to those not on antiplatelet therapy after adjustment for confounders, CONCLUSIONS: Pre-injury antiplatelet therapy is associated with a decreased risk of lung dysfunction, multiple organ failure, and possibly mortality in high-risk blunt trauma patients who received blood transfusions. These findings suggest platelets have a role in organ dysfunction development and have potential therapeutic implications.

Authors:	Jeffrey N Harr; Ernest E Moore; Jeffrey Johnson; Theresa L Chin; Max V Wohlauer; Ronald Maier; Joseph Cuschieri; Jason Sperry; Anirban Banerjee; Christopher C Silliman; Angela Sauaia
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Publication Detail:	Type: Journal Article; Multicenter Study; Research Support, N.I.H., Extramural
Journal Detail:	Title: Critical care medicine Volume: 41 ISSN: 1530-0293 ISO Abbreviation: Crit. Care Med. Publication Date: 2013 Feb
Date Detail:	Created Date: 2013-01-28 Completed Date: 2013-04-08 Revised Date: 2013-04-16
Medline Journal Info:	Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States
Other Details:	Languages: eng Pagination: 399-404 Citation Subset: AIM; IM
Affiliation:	Department of Surgery, University of Colorado Denver, Aurora, CO 80045, USA. jeffrey.harr@ucdenver.edu
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MeSH Terms
Descriptor/Qualifier:	Acute Lung Injury / classification, epidemiology* Blood Transfusion / statistics & numerical data* Cohort Studies Female Humans Injury Severity Score Male Middle Aged Multiple Organ Failure / classification, epidemiology* Multivariate Analysis Platelet Aggregation Inhibitors / therapeutic use* Risk Assessment United States / epidemiology Wounds and Injuries / mortality*
Grant Support
ID/Acronym/Agency:	P50 GM049222/GM/NIGMS NIH HHS; P50 GM049222/GM/NIGMS NIH HHS; T32 GM008315/GM/NIGMS NIH HHS; T32 GM008315/GM/NIGMS NIH HHS; U54 GM062119/GM/NIGMS NIH HHS
Chemical
Reg. No./Substance:	0/Platelet Aggregation Inhibitors
Comments/Corrections
Comment In:	Crit Care Med. 2013 Feb;41(2):659 [PMID: 23353944 ]

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