title: The impact of antiplatelet drugs on trauma outcomes.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Universityof Kentucky, Lexington, Kentucky 40536-0284, USA. ferraris@earthlink.net
authors.forename: Victor A
authors.initials: VA
authors.lastname: Ferraris
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Bernard
authors.forename: Brannon
authors.initials: B
authors.lastname: Hyde
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D011300:Preoperative Care; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014193:Trauma Centers; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*
chemical_list: D010975:Platelet Aggregation Inhibitors