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The use of nonsteroidal anti-inflammatory drugs before hospital admission for severe blunt injury is associated with a reduced incidence of trauma-induced coagulopathy, results from a secondary analysis of a prospective cohort study demonstrated.
"Although trauma-induced coagulopathy [TIC] has been increasingly recognized as a critical component of the pathophysiology of trauma and hemorrhagic shock, factors that predict the development of TIC remain largely unexplored," researchers led by Dr. Matthew D. Neal wrote in a study published in Annals of Surgery.
"The lack of ability to predict TIC makes the design of therapeutic interventions challenging, especially considering that TIC seems to develop rapidly and early after injury."
They noted that previous studies from the trauma literature "have linked the development of TIC to alterations in the thrombomodulin protein C pathway and excessive activated protein C activation, resulting in impaired coagulation. These data present a potential link between TIC and inflammation, which is a common finding in other conditions where both sterile (such as myocardial infarction) and pathogen-mediated (sepsis) diseases present with coagulopathy."
In an effort to investigate whether the use of prehospital NSAIDs may lead to a reduced incidence of TIC, the researchers performed a secondary analysis of 1,897 subjects in the Inflammation and the Host Response to Injury program, which is a large-scale, multicenter study of adults who present with hemorrhagic shock after blunt injury and is designed to characterize the genomic and proteomic response after injury. The key outcome of interest was TIC, which was defined as an admission international normalized ratio (INR) of more than 1.5, or clinically significant coagulopathy, which was defined as that which required transfusion of more than 2 units of fresh frozen plasma or more than 1 pack of platelets in the first 6 hours after admission to the trauma center.
Dr. Neal, of the division of general surgery in the department of surgery at the University of Pittsburgh Medical Center, and his associates used logistic regression to evaluate the association between TIC and prehospital medications and comorbidities (Ann. Surg. 2014;260:378-82). A total of 15 medications or medication classes were assessed, including NSAIDs, aspirin, beta-blockers, antihypertensive medications, oral contraceptives, and corticosteroids.
The mean age of the study population was 40 years, 66% were male, and the mean time from injury to admission was 78 minutes. Nearly one-quarter of the subjects (22%) presented with an INR of more than 1.5, 46% received more than 2 units of fresh frozen plasma or more than 1 pack of platelets in the first 6 hours after admission, and 15% met criteria for both TIC and significant coagulopathy. The most common prehospital medications were antihypertensive medications (12%) and statins (6%).
After performing stepwise logistic regression of the data, the researchers found that prehospital use of NSAIDs was associated with a 72% reduced risk of TIC and was the only medication to retain significance in the model. Stepwise logistic regression also demonstrated that the prehospital use of NSAIDs was associated with a 66% lower risk of clinical significant coagulopathy. The findings were independent of comorbid conditions linked to NSAID use. "None of the interaction terms for NSAID use and associated comorbidities reached significance, and, in fact, two of these, myocardial infarction and hyperlipidemia, were actually associated with an increased risk of clinically significant coagulopathy," the researchers wrote.
Reasons that other anti-inflammatory agents did not have the same association with reduced incidence of TIC "could be explained by a potential off-target effect of NSAIDs or may be due to the complexity of the link between the inflammatory cascade and the induction of coagulopathy."
Dr. Neal and his associates acknowledged certain limitations of the study, including the fact that it was a secondary analysis of a prospective cohort study; that variables regarding medication use, dose, and compliance were not recorded; and that all patients in the cohort were injured by blunt means and presented in hemorrhagic shock. "This may limit the applicability of the results and conclusions to other cohorts," they wrote. "Potential unknown or unmeasured confounding variables may be responsible for the associations described and the conclusions formulated."
The study was supported by a grant from the National Institutes of Health. The researchers had no relevant financial conflicts to disclose.
The use of nonsteroidal anti-inflammatory drugs before hospital admission for severe blunt injury is associated with a reduced incidence of trauma-induced coagulopathy, results from a secondary analysis of a prospective cohort study demonstrated.
"Although trauma-induced coagulopathy [TIC] has been increasingly recognized as a critical component of the pathophysiology of trauma and hemorrhagic shock, factors that predict the development of TIC remain largely unexplored," researchers led by Dr. Matthew D. Neal wrote in a study published in Annals of Surgery.
"The lack of ability to predict TIC makes the design of therapeutic interventions challenging, especially considering that TIC seems to develop rapidly and early after injury."
They noted that previous studies from the trauma literature "have linked the development of TIC to alterations in the thrombomodulin protein C pathway and excessive activated protein C activation, resulting in impaired coagulation. These data present a potential link between TIC and inflammation, which is a common finding in other conditions where both sterile (such as myocardial infarction) and pathogen-mediated (sepsis) diseases present with coagulopathy."
In an effort to investigate whether the use of prehospital NSAIDs may lead to a reduced incidence of TIC, the researchers performed a secondary analysis of 1,897 subjects in the Inflammation and the Host Response to Injury program, which is a large-scale, multicenter study of adults who present with hemorrhagic shock after blunt injury and is designed to characterize the genomic and proteomic response after injury. The key outcome of interest was TIC, which was defined as an admission international normalized ratio (INR) of more than 1.5, or clinically significant coagulopathy, which was defined as that which required transfusion of more than 2 units of fresh frozen plasma or more than 1 pack of platelets in the first 6 hours after admission to the trauma center.
Dr. Neal, of the division of general surgery in the department of surgery at the University of Pittsburgh Medical Center, and his associates used logistic regression to evaluate the association between TIC and prehospital medications and comorbidities (Ann. Surg. 2014;260:378-82). A total of 15 medications or medication classes were assessed, including NSAIDs, aspirin, beta-blockers, antihypertensive medications, oral contraceptives, and corticosteroids.
The mean age of the study population was 40 years, 66% were male, and the mean time from injury to admission was 78 minutes. Nearly one-quarter of the subjects (22%) presented with an INR of more than 1.5, 46% received more than 2 units of fresh frozen plasma or more than 1 pack of platelets in the first 6 hours after admission, and 15% met criteria for both TIC and significant coagulopathy. The most common prehospital medications were antihypertensive medications (12%) and statins (6%).
After performing stepwise logistic regression of the data, the researchers found that prehospital use of NSAIDs was associated with a 72% reduced risk of TIC and was the only medication to retain significance in the model. Stepwise logistic regression also demonstrated that the prehospital use of NSAIDs was associated with a 66% lower risk of clinical significant coagulopathy. The findings were independent of comorbid conditions linked to NSAID use. "None of the interaction terms for NSAID use and associated comorbidities reached significance, and, in fact, two of these, myocardial infarction and hyperlipidemia, were actually associated with an increased risk of clinically significant coagulopathy," the researchers wrote.
Reasons that other anti-inflammatory agents did not have the same association with reduced incidence of TIC "could be explained by a potential off-target effect of NSAIDs or may be due to the complexity of the link between the inflammatory cascade and the induction of coagulopathy."
Dr. Neal and his associates acknowledged certain limitations of the study, including the fact that it was a secondary analysis of a prospective cohort study; that variables regarding medication use, dose, and compliance were not recorded; and that all patients in the cohort were injured by blunt means and presented in hemorrhagic shock. "This may limit the applicability of the results and conclusions to other cohorts," they wrote. "Potential unknown or unmeasured confounding variables may be responsible for the associations described and the conclusions formulated."
The study was supported by a grant from the National Institutes of Health. The researchers had no relevant financial conflicts to disclose.
The use of nonsteroidal anti-inflammatory drugs before hospital admission for severe blunt injury is associated with a reduced incidence of trauma-induced coagulopathy, results from a secondary analysis of a prospective cohort study demonstrated.
"Although trauma-induced coagulopathy [TIC] has been increasingly recognized as a critical component of the pathophysiology of trauma and hemorrhagic shock, factors that predict the development of TIC remain largely unexplored," researchers led by Dr. Matthew D. Neal wrote in a study published in Annals of Surgery.
"The lack of ability to predict TIC makes the design of therapeutic interventions challenging, especially considering that TIC seems to develop rapidly and early after injury."
They noted that previous studies from the trauma literature "have linked the development of TIC to alterations in the thrombomodulin protein C pathway and excessive activated protein C activation, resulting in impaired coagulation. These data present a potential link between TIC and inflammation, which is a common finding in other conditions where both sterile (such as myocardial infarction) and pathogen-mediated (sepsis) diseases present with coagulopathy."
In an effort to investigate whether the use of prehospital NSAIDs may lead to a reduced incidence of TIC, the researchers performed a secondary analysis of 1,897 subjects in the Inflammation and the Host Response to Injury program, which is a large-scale, multicenter study of adults who present with hemorrhagic shock after blunt injury and is designed to characterize the genomic and proteomic response after injury. The key outcome of interest was TIC, which was defined as an admission international normalized ratio (INR) of more than 1.5, or clinically significant coagulopathy, which was defined as that which required transfusion of more than 2 units of fresh frozen plasma or more than 1 pack of platelets in the first 6 hours after admission to the trauma center.
Dr. Neal, of the division of general surgery in the department of surgery at the University of Pittsburgh Medical Center, and his associates used logistic regression to evaluate the association between TIC and prehospital medications and comorbidities (Ann. Surg. 2014;260:378-82). A total of 15 medications or medication classes were assessed, including NSAIDs, aspirin, beta-blockers, antihypertensive medications, oral contraceptives, and corticosteroids.
The mean age of the study population was 40 years, 66% were male, and the mean time from injury to admission was 78 minutes. Nearly one-quarter of the subjects (22%) presented with an INR of more than 1.5, 46% received more than 2 units of fresh frozen plasma or more than 1 pack of platelets in the first 6 hours after admission, and 15% met criteria for both TIC and significant coagulopathy. The most common prehospital medications were antihypertensive medications (12%) and statins (6%).
After performing stepwise logistic regression of the data, the researchers found that prehospital use of NSAIDs was associated with a 72% reduced risk of TIC and was the only medication to retain significance in the model. Stepwise logistic regression also demonstrated that the prehospital use of NSAIDs was associated with a 66% lower risk of clinical significant coagulopathy. The findings were independent of comorbid conditions linked to NSAID use. "None of the interaction terms for NSAID use and associated comorbidities reached significance, and, in fact, two of these, myocardial infarction and hyperlipidemia, were actually associated with an increased risk of clinically significant coagulopathy," the researchers wrote.
Reasons that other anti-inflammatory agents did not have the same association with reduced incidence of TIC "could be explained by a potential off-target effect of NSAIDs or may be due to the complexity of the link between the inflammatory cascade and the induction of coagulopathy."
Dr. Neal and his associates acknowledged certain limitations of the study, including the fact that it was a secondary analysis of a prospective cohort study; that variables regarding medication use, dose, and compliance were not recorded; and that all patients in the cohort were injured by blunt means and presented in hemorrhagic shock. "This may limit the applicability of the results and conclusions to other cohorts," they wrote. "Potential unknown or unmeasured confounding variables may be responsible for the associations described and the conclusions formulated."
The study was supported by a grant from the National Institutes of Health. The researchers had no relevant financial conflicts to disclose.
FROM ANNALS OF SURGERY
Key clinical point: Prehospital use of NSAIDs is linked to a reduced incidence of trauma-induced coagulopathy (TIC).
Major finding:. On stepwise regression analysis, prehospital use of NSAIDs was associated with a 72% reduced risk of TIC and was the only medication to retain significance in the model.
Data source: A secondary analysis of 1,897 subjects in the Inflammation and the Host Response to Injury program, which is a multicenter study of adults who present with hemorrhagic shock after blunt injury.
Disclosures: The study was supported by a grant from the National Institutes of Health. The researchers had no relevant financial conflicts to disclose.
