title: Antiplatelet therapy is associated with decreased transfusion-associated risk of lung dysfunction, multiple organ failure, and mortality in trauma patients.
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.
  
  
  METHODS
  Secondary analysis of a cohort enrolled in the National Institute of General Medical Sciences Trauma Glue Grant database.
  
  
  METHODS
  Multicenter study including nine U.S. level-1 trauma centers.
  
  
  METHODS
  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.
  
  
  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.affiliation: Department of Surgery, University of Colorado Denver, Aurora, CO 80045, USA. jeffrey.harr@ucdenver.edu
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Harr
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Johnson
authors.forename: Theresa L
authors.initials: TL
authors.lastname: Chin
authors.forename: Max V
authors.initials: MV
authors.lastname: Wohlauer
authors.forename: Ronald
authors.initials: R
authors.lastname: Maier
authors.forename: Joseph
authors.initials: J
authors.lastname: Cuschieri
authors.forename: Jason
authors.initials: J
authors.lastname: Sperry
authors.forename: Anirban
authors.initials: A
authors.lastname: Banerjee
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Silliman
authors.forename: Angela
authors.initials: A
authors.lastname: Sauaia
mesh_terms: D055371:Acute Lung Injury / Q000145:classification / Q000453:epidemiology*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000145:classification / Q000453:epidemiology*; D015999:Multivariate Analysis; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality*
chemical_list: D010975:Platelet Aggregation Inhibitors