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

Abstract

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.

The preventive effect of antiplatelet therapy in acute respiratory distress syndrome: a meta-analysis

“…In observational studies, antiplatelet therapy was associated with a reduced incidence of ARDS but not of mortality. A previous meta-analysis conducted by Wang et al and Mohananey et al revealed decreased mortality among critically ill patients receiving antiplatelet therapy [ 25 , 40 ]. Notably, they included studies that did not report the incidence of ARDS [ 37 , 41 – 51 ] and possibly included patients at a lower risk of ARDS, which may confound the result [ 43 , 48 – 51 ].…”

Pharmacokinetic Profiles of Ticagrelor Orodispersible Tablets in Healthy Western and Japanese Subjects

“…Such patients include those who are unconscious, sedated, critically ill [ 24 ], elderly [ 25 ], or have dysphagia [ 26 ]. Moreover, all these scenarios are likely to be applicable to patients with cardiovascular disease [ 28 – 31 ] who may require antiplatelet therapy. Based on the current results, the ticagrelor OD tablet is considered a suitable alternative formulation to the 90-mg ticagrelor IR tablet for patients who are unable to swallow whole tablets, for whom there is a preference for an OD formulation, or for those who require nasogastric administration.…”

“…Furthermore, dysphagia, a common problem in adults (~4% incidence in the USA [ 26 ]), may result in drug administration errors [ 27 ]. Such patients who are unable to take tablets encompass those with cardiovascular disease [ 28 – 31 ] who may need antiplatelet therapy.…”

Coagulopathy in COVID-19

“…[ 47 ] Some studies suggest that antiplatelet therapy is associated with reduced mortality and lower incidence of ARDS/ALI. [ 48 49 ] Based on existing findings, antiplatelet agents may be effective in improving outcomes in patients with COVID-19.…”