Antiplatelet Therapy Is Associated With Decreased Transfusion-Associated Risk of Lung Dysfunction, Multiple Organ Failure, and Mortality in Trauma Patients

作者：Harr Jeffrey N^*; Moore Ernest E; Johnson Jeffrey; Chin Theresa L; Wohlauer Max V; Maier Ronald; Cuschieri Joseph; Sperry Jason; Banerjee Anirban; Silliman Christopher C; Sauaia Angela

来源：Critical Care Medicine, 2013, 41(2): 399-404.

DOI：10.1097/CCM.0b013e31826ab38b

• antiplatelet agents
• blood transfusion
• lung dysfunction
• multiple organ failure
• trauma

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-1 trauma 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 dysdefined 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. (Crit Care Med 2013;41:399-404)

• 出版日期2013-2