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The impact of antiplatelet drugs on trauma outcomes

Ferraris, Victor A. MD, PhD; Bernard, Andrew C. MD; Hyde, Brannon MD; Kearney, Paul A. MD

Journal of Trauma and Acute Care Surgery: August 2012 - Volume 73 - Issue 2 - p 492–497
doi: 10.1097/TA.0b013e31825b85f1
EAST 2012 POSTER PAPERS
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BACKGROUND Antiplatelet drugs (APDs) are among the most commonly prescribed medications. We wondered whether patients with trauma receiving preinjury APD have worse outcomes.

METHODS We interrogated our institutional database during a 5-year period to evaluate preoperative risks and trauma outcomes in patients taking APDs before traumatic injury. We used propensity balancing scores to adjust for preoperative risks in assessing outcomes in APD-treated patients.

RESULTS During a 5-year period, 1,327 (11.7%) of 11,374 adult patients with trauma took APDs before injury. The yearly use of APD in patients with trauma increased nearly threefold during the study period. Cardiac, pulmonary, and renal comorbidities were significantly more common in APD-treated patients. Multivariate regression indicated that preinjury APDs predicted significantly worse composite morbidity and mortality. After propensity adjustment for preinjury risk factors, APD-treated patients demonstrated significantly increased composite morbidity (39.0 vs. 24.6%, p = 0.037) and cardiac complications (23.0 vs. 17.3%, p = 0.017) compared with patients without APDs. The type and intensity of APD conferred an incremental risk, with patients taking dual APDs having a significantly worse multivariate risk of adverse outcomes compared with patients taking a single APD.

CONCLUSION APD-treated patients with trauma have significantly more comorbidities compared with those not taking APDs. After adjusting for preoperative risks, APD-treated patients have significantly worse trauma outcomes. Dual APD treatment confers an incremental risk of adverse outcomes compared with single APD preinjury treatment. The number of patients with trauma taking APDs increased during the 5-year study period, so we speculate that trauma management of patients taking APDs will occur more commonly in the future.

LEVEL OF EVIDENCE Prognostic study, level III.

Supplemental digital content is available in the article.

From the Divisions of Cardiovascular and Thoracic Surgery (V.A.F., B.H.), and Trauma and Critical Care (A.C.B., P.A.K.), Department of Surgery, University of Kentucky, Lexington, Kentucky.

Submitted: November 30, 2011, Revised: April 16, 2012, Accepted: April 19, 2012.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.-com).

Address for reprints: Victor A. Ferraris, MD, PhD, Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Kentucky, A301 Kentucky Clinic, 740 South Limestone, Lexington, KY 40536-0284; email: ferraris@earthlink.net.

© 2012 Lippincott Williams & Wilkins, Inc.