Document Detail


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:  2014-11-09    
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    
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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; R24 GM102656/GM/NIGMS NIH HHS; T32 GM008315/GM/NIGMS NIH HHS; T32 GM008315/GM/NIGMS NIH HHS; U54 GM062119/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 Aug;41(8):e187-8   [PMID:  23863258 ]
Crit Care Med. 2013 Feb;41(2):659   [PMID:  23353944 ]
Crit Care Med. 2013 Jun;41(6):e98-9   [PMID:  23685605 ]
Crit Care Med. 2013 Aug;41(8):e189   [PMID:  23863260 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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