title: Prehospital use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with a reduced incidence of trauma-induced coagulopathy.
abstract: OBJECTIVE
  To determine whether prehospital nonsteroidal anti-inflammatory drug (NSAID) use may lead to a reduced incidence of trauma-induced coagulopathy (TIC) in severely injured patients.
  
  
  BACKGROUND
  TIC is present in up to a quarter of severely injured trauma patients and is linked to worse outcomes after injury. Evidence linking TIC to inflammation has emerged; however, the mechanism behind this association is still under investigation. NSAIDs are commonly used anti-inflammatory drugs, but their effects on TIC and outcomes after injury are largely unexplored.
  
  
  METHODS
  We performed a secondary analysis of the Inflammation and the Host Response to Injury Large Scale Collaborative Program (Glue Grant) data set. Prehospital medications and comorbidities were analyzed by logistic regression analysis for association with TIC as defined by laboratory (international normalized ratio >1.5) or clinical (transfusion >2 units of fresh frozen plasma or >1 pack of platelets in 6 hours) parameters.
  
  
  RESULTS
  Prehospital NSIAD use was independently associated with a 72% lower risk of TIC and was the only medication among 15 analyzed to retain significance in the model. Stepwise logistic regression also demonstrated that preadmission use of NSAIDs was independently associated with a 66% lower risk of clinically significant coagulopathy. These findings were independent of comorbid conditions linked to NSAID use.
  
  
  CONCLUSIONS
  NSAID use before admission for severe injury is associated with a reduced incidence of TIC. These findings provide further evidence to a potential leak between TIC and inflammation.
authors.affiliation: *Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; †Department of Surgery, Denver Health Medical Center and The University of Colorado Health Sciences Center, Denver; ‡Division of General Surgery and Trauma, Harborview Medical Center and the Department of Surgery, University of Washington, Seattle; §Division of Burn, Trauma, Critical Care, Department of Surgery, University of Texas Southwestern Medical Center, Dallas; and ¶Department of Surgery, University of California, San Francisco.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Neal
authors.forename: Joshua B
authors.initials: JB
authors.lastname: Brown
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.forename: Joseph
authors.initials: J
authors.lastname: Cuschieri
authors.forename: Ronald V
authors.initials: RV
authors.lastname: Maier
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Minei
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Billiar
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Peitzman
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Cohen
authors.forename: Jason L
authors.initials: JL
authors.lastname: Sperry
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000453:epidemiology* / Q000209:etiology; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000150:complications* / Q000628:therapy*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal