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Original Research: CRITICAL CARE |

Prehospitalization Antiplatelet Therapy Is Associated With a Reduced Incidence of Acute Lung Injury: A Population-Based Cohort Study

Jason M. Erlich, MD; Daniel S. Talmor, MD, FCCP; Rodrigo Cartin-Ceba, MD; Ognjen Gajic, MD, FCCP; Daryl J. Kor, MD
Author and Funding Information

From the Department of Anesthesia (Drs Erlich and Talmor), Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; and Department of Medicine (Drs Cartin-Ceba and Gajic), Division of Pulmonary and Critical Care Medicine, and Department of Anesthesiology (Dr Kor), Division of Critical Care Medicine, Multidisciplinary Epidemiology and Translational Research in Intensive Medicine, Mayo Clinic, Rochester, MN.

Correspondence to: Daryl J. Kor, MD, Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: kor.daryl@mayo.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Funding/Support: This work was supported by the National Center for Research Resources [grant number KL2 RR024151], a component of the National Institutes of Health (NIH) and the NIH Roadmap for Medical Research.


© 2011 American College of Chest Physicians


Chest. 2011;139(2):289-295. doi:10.1378/chest.10-0891
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Background:  Acute lung injury (ALI) is a potentially fatal lung disease with few treatment options. Platelet activation is a key component of ALI pathophysiology and may provide an opportunity for prevention strategies. We examined the association of prehospitalization antiplatelet therapy with development of ALI in critically ill patients.

Methods:  All Olmsted County, Minnesota, residents with a medical ICU admission in the year 2006 were evaluated. Patients with at least one major risk factor for ALI who did not meet criteria for ALI at the time of hospital admission were included in the analysis. Baseline characteristics, major risk factors for ALI, the presence of antiplatelet therapy at the time of hospitalization, and the propensity to receive this therapy were determined. The primary outcome was ALI or ARDS during the hospitalization. Secondary outcomes were ICU and hospital-free days and ICU and hospital mortality.

Results:  A total of 161 patients were evaluated. Seventy-nine (49%) were receiving antiplatelet therapy at hospital admission; 33 (21%) developed ALI/ARDS. Antiplatelet therapy was associated with a reduced incidence of ALI/ARDS (12.7% vs 28.0%; OR, 0.37; 95% CI, 0.16-0.84; P = .02). This association remained significant after adjusting for confounding variables.

Conclusions:  Prehospitalization antiplatelet therapy was associated with a reduced incidence of ALI/ARDS. If confirmed in a more diverse patient population, these results would support the use of antiplatelet agents in an ALI prevention trial.

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