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.