Prehospitalization antiplatelet therapy is associated with a reduced incidence of acute lung injury: a population-based cohort study.
BACKGROUND
Acute lung injury (ALI) is a potentially fatal lung disease with few treatment options. Platelet activation is a key component of ALI pathophysiology and may provide an opportunity for prevention strategies. We examined the association of prehospitalization antiplatelet therapy with development of ALI in critically ill patients.


METHODS
All Olmsted County, Minnesota, residents with a medical ICU admission in the year 2006 were evaluated. Patients with at least one major risk factor for ALI who did not meet criteria for ALI at the time of hospital admission were included in the analysis. Baseline characteristics, major risk factors for ALI, the presence of antiplatelet therapy at the time of hospitalization, and the propensity to receive this therapy were determined. The primary outcome was ALI or ARDS during the hospitalization. Secondary outcomes were ICU and hospital-free days and ICU and hospital mortality.


RESULTS
A total of 161 patients were evaluated. Seventy-nine (49%) were receiving antiplatelet therapy at hospital admission; 33 (21%) developed ALI/ARDS. Antiplatelet therapy was associated with a reduced incidence of ALI/ARDS (12.7% vs 28.0%; OR, 0.37; 95% CI, 0.16-0.84; P = .02). This association remained significant after adjusting for confounding variables.


CONCLUSIONS
Prehospitalization antiplatelet therapy was associated with a reduced incidence of ALI/ARDS. If confirmed in a more diverse patient population, these results would support the use of antiplatelet agents in an ALI prevention trial.
Erlich
Jason M
JM
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
Talmor
Daniel S
DS
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
Cartin-Ceba
Rodrigo
R
Department of Medicine, Division of Critical Care Medicine, Multidisciplinary Epidemiology and Translational Research in Intensive Medicine, Mayo Clinic, Rochester, MN.
Gajic
Ognjen
O
Department of Medicine, Division of Critical Care Medicine, Multidisciplinary Epidemiology and Translational Research in Intensive Medicine, Mayo Clinic, Rochester, MN.
Kor
Daryl J
DJ
Division of Pulmonary and Critical Care Medicine, and Department of Anesthesiology, Division of Critical Care Medicine, Multidisciplinary Epidemiology and Translational Research in Intensive Medicine, Mayo Clinic, Rochester, MN. Electronic address: kor.daryl@mayo.edu.
D055371:Acute Lung Injury / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D000368:Aged; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
D010975:Platelet Aggregation Inhibitors