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Effect of antiplatelet therapy on mortality and acute lung injury in critically ill patients: A systematic review and meta-analysis


1 Department of Internal Medicine, John H Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, USA
2 Division of Cardiovascular Diseases, Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY 10461, USA
3 Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
4 Department of Cardiovascular Medicine, St. Lukes University Health Network, Bethlehem, PA 18015, USA
5 Department of Internal Medicine, University of Louisville, Louisville, KY 40292, USA
6 Division of Cardiovascular Diseases, 13400 East Mayo Boulevard, Mayo Clinic, Scottsdale, AZ 85259, USA
7 Department of Anesthesiology, Hospital of the University of Pennsylvania, 6 Dulles, Philadelphia, PA 19104, USA
8 Department of Anesthesiology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ, USA

Correspondence Address:
Harish Ramakrishna
Department of Anesthesiology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.191576

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Year : 2016  |  Volume : 19  |  Issue : 4  |  Page : 626-637

 

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Aim: Platelet function is intricately linked to the pathophysiology of critical Illness, and some studies have shown that antiplatelet therapy (APT) may decrease mortality and incidence of acute respiratory distress syndrome (ARDS) in these patients. Our objective was to understand the efficacy of APT by conducting a meta-analysis. Materials and Methods: We conducted a meta-analysis using PubMed, Central, Embase, The Cochrane Central Register, the ClinicalTrials.gov Website, and Google Scholar. Studies were included if they investigated critically ill patients receiving antiplatelet therapy and mentioned the outcomes being studied (mortality, duration of hospitalization, ARDS, and need for mechanical ventilation). Results: We found that there was a significant reduction in all-cause mortality in patients on APT compared to control (odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.70–0.97). Both the incidence of acute lung injury/ARDS (OR: 0.67; 95% CI: 0.57–0.78) and need for mechanical ventilation (OR: 0.74; 95% CI: 0.60–0.91) were lower in the antiplatelet group. No significant difference in duration of hospitalization was observed between the two groups (standardized mean difference: −0.02; 95% CI: −0.11–0.07). Conclusion: Our meta-analysis suggests that critically ill patients who are on APT have an improved survival, decreased incidence of ARDS, and decreased need for mechanical ventilation.






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1 Department of Internal Medicine, John H Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, USA
2 Division of Cardiovascular Diseases, Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY 10461, USA
3 Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
4 Department of Cardiovascular Medicine, St. Lukes University Health Network, Bethlehem, PA 18015, USA
5 Department of Internal Medicine, University of Louisville, Louisville, KY 40292, USA
6 Division of Cardiovascular Diseases, 13400 East Mayo Boulevard, Mayo Clinic, Scottsdale, AZ 85259, USA
7 Department of Anesthesiology, Hospital of the University of Pennsylvania, 6 Dulles, Philadelphia, PA 19104, USA
8 Department of Anesthesiology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ, USA

Correspondence Address:
Harish Ramakrishna
Department of Anesthesiology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.191576

Rights and Permissions

Aim: Platelet function is intricately linked to the pathophysiology of critical Illness, and some studies have shown that antiplatelet therapy (APT) may decrease mortality and incidence of acute respiratory distress syndrome (ARDS) in these patients. Our objective was to understand the efficacy of APT by conducting a meta-analysis. Materials and Methods: We conducted a meta-analysis using PubMed, Central, Embase, The Cochrane Central Register, the ClinicalTrials.gov Website, and Google Scholar. Studies were included if they investigated critically ill patients receiving antiplatelet therapy and mentioned the outcomes being studied (mortality, duration of hospitalization, ARDS, and need for mechanical ventilation). Results: We found that there was a significant reduction in all-cause mortality in patients on APT compared to control (odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.70–0.97). Both the incidence of acute lung injury/ARDS (OR: 0.67; 95% CI: 0.57–0.78) and need for mechanical ventilation (OR: 0.74; 95% CI: 0.60–0.91) were lower in the antiplatelet group. No significant difference in duration of hospitalization was observed between the two groups (standardized mean difference: −0.02; 95% CI: −0.11–0.07). Conclusion: Our meta-analysis suggests that critically ill patients who are on APT have an improved survival, decreased incidence of ARDS, and decreased need for mechanical ventilation.






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