Plaquetas Fom

Antiplatelet Therapy Is Associated With Decreased Transfusion-Associated Risk of Lung Dysfunction, Multiple Organ Failure, and Mortality in Trauma Patients*
Jeffrey N. Harr, MD, MPH1; Ernest E. Moore, MD1,2; Jeffrey Johnson, MD1,2; Theresa L. Chin, MD1; Max V. Wohlauer, MD1; Ronald Maier, MD3; Joseph Cuschieri, MD3; Jason Sperry, MD4; Anirban Banerjee, PhD1; Christopher C. Silliman, MD1,5;Angela Sauaia, MD, PhD1
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. Design: Secondary analysis of a cohort enrolled in the National Institute of General Medical Sciences Trauma Glue Grant database. Setting: Multicenter study including nine U.S. level-1trauma centers. Patients: 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. Measurements and Main Results: Primary outcomes were lung dysfunction (defined as grades 2–3 by the Denver multiple organ failurescore), 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 1700mL (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 andmultiple 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-injuryantiplatelet 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. (Crit Care Med 2013; 41:399–404) Key Words: antiplatelet agents; blood transfusion; lungdysfunction; multiple organ failure; trauma

*See also p. 659. 1 Department of Surgery, University of Colorado Denver, Aurora, CO. 2 Department of Surgery, Denver Health Medical Center, Denver, CO. 3 Department of Surgery, University of Washington, Seattle, WA. 4 Department of Surgery, University of Pittsburgh, Pittsburgh, PA. 5 Research Department, Bonfils Blood Center, Denver, CO. This studywas supported by the National Institutes of Health (U54 GM062119, P50 GM049222, and T32 GM008315 grants). The authors have not disclosed any potential conflicts of interest. Address requests for reprints to: Jeffrey N. Harr, MD, MPH, University of Colorado Denver, Trauma Research Center, Mail Stop C-320, RC2 Building, Room No. P15-6420 A-F, 12700 E. 19th Avenue, Aurora, CO 80045. E-mail:jeffrey.harr@ucdenver.edu Copyright © 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins DOI: 10.1097/CCM.0b013e31826ab38b

L

ung dysfunction remains a leading cause of morbidity and mortality among critically ill patients (1). Ultimately, progression to acute respiratory distress syndrome (ARDS) and multiple organ failure (MOF) may ensue, further worsening outcomes. In...