J. Kuhlman1,3, A. LaRiccia1,2,3, A. Ngo1,3, J. Sarver1,3, S. Hyland4, M. Spalding1,2,3, J. Hill1 4OhioHealth Grant Medical Center,Department Of Pharmacy Services,Columbus, OHIO, USA 1OhioHealth Grant Medical Center,Division Of Trauma And Acute Care Surgery,Columbus, OH, USA 2OhioHealth Doctors Hospital,Department Of Surgery,Columbus, OHIO, USA 3Ohio University Heritage College of Osteopathic Medicine,Dublin, OH, USA
Introduction: Non-steroidal anti-inflammatory drugs (NSAIDs) are an effective non-opiate option for pain control however the anti-platelet aggregation of COX-1 inhibitors is a concern for patients with solid organ injuries. The aim of the study is to explore the potential complications in solid organ injury patients given NSAIDs during their hospital course. We hypothesized the use NSAIDs would not contribute to intra-abdominal bleed progression.
Methods: This is an IRB approved retrospective chart review of blunt trauma patients evaluated from 6/1/2015 to 6/30/2019 at an urban level 1 trauma center. Patients were included if they had a solid organ injury. Exclusion criteria included patients with bleeding disorders, on home anti-platelet or anticoagulation, pregnancy, death within 24 hours and prisoners. Odds ratio was used to compare those taking NSAIDs versus those not taking for both packed red blood cell (PRBC) transfusion needs and need for operative intervention or angioembolization. Chi-square test was used with P<0.05 to determine significance. Cumulative NSAID doses were compared in 6 month intervals using Fisher’s exact test.
Results: After exclusion criteria was applied, 803 patients were analyzed; 195 were given NSAIDs during their hospital course. NSAID prescribing did not increase at a statistically significant rate (F-test P =0.74). Patients given NSAIDs early in their hospital course or prior to a procedure had an increased likelihood of requiring an operation (OR 16.6; 95% CI 6.1-45.6; P < 0.05). When controlled for ISS taking NSAIDs early in the hospital course or prior to intervention continued to be a significant predictor of requiring an intervention (OR 17.8; 95% CI 6.5-49.1; P<0.05). Patients taking ibuprofen were less likely to receive a PRBC transfusion (OR 2.8; 95% CI 1.7-4.8; P <0.05).
Conclusion: The use of NSAIDs in patients with solid organ injuries has a theoretical risk of increasing intra-abdominal bleeding secondary to inhibition of platelet aggregation. While these patients were less likely to need a PRBC transfusion, the likelihood in our study of receiving a procedure for those given NSAIDs early in the hospital course was higher, even when controlled for ISS. Although at an increased risk for procedures, these interventions did not affect mortality outcomes. Other factors besides NSAID use could be contributing to the increased likelihood of requiring a procedure in this specific population including original injury grade and organ injured. Our findings indicate caution should be exercised when prescribing NSAIDs as an adjunct to opiates to patients with solid organ injuries. Future areas of study are needed to explore more variables associated with the increased risk of procedural intervention.