Skip Navigation LinksHome > February 2013 - Volume 41 - Issue 2 > Antiplatelet Therapy Is Associated With Decreased Transfusio...
Critical Care Medicine:
doi: 10.1097/CCM.0b013e31826ab38b
Feature Articles

Antiplatelet Therapy Is Associated With Decreased Transfusion-Associated Risk of Lung Dysfunction, Multiple Organ Failure, and Mortality in Trauma Patients*

Harr, Jeffrey N. MD, MPH1; Moore, Ernest E. MD1,2; Johnson, Jeffrey MD1,2; Chin, Theresa L. MD1; Wohlauer, Max V. MD1; Maier, Ronald MD3; Cuschieri, Joseph MD3; Sperry, Jason MD4; Banerjee, Anirban PhD1; Silliman, Christopher C. MD1,5; Sauaia, Angela MD, PhD1

Collapse Box

Abstract

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.

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

Article Tools

Share

Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.