Effects of Pre-Hospital Antiplatelet Therapy on the Incidence of ARDS

Abstract

BACKGROUND: Clinical observations on the potential of pre-hospital antiplatelet therapy in preventing ARDS have been inconsistent. To further the correlation between antiplatelet therapy and ARDS, we conducted a meta-analysis to evaluate the effects of pre-hospital antiplatelet therapy on subjects with ARDS. METHODS: A literature search in major data banks was performed. We included prospective and retrospective cohorts, case-control trials, and randomized controlled trials that compared the ARDS incidence in subjects with or without pre-hospital antiplatelet agents. RESULTS: Meta-analysis of 7 studies (a total of 30,291 subjects) showed significantly lower odds of ARDS in the pre-hospital antiplatelet therapy group compared with subjects with no pre-hospital antiplatelet therapy (odds ratio 0.68, 95% CI 0.56-0.83; P < .001). However, ARDS mortalities in the hospital and ICUs were not affected. CONCLUSIONS: These findings indicated that pre-hospital antiplatelet therapy was associated with a reduced rate of ARDS but had no effect on the mortality in the subjects at high risk.

Guidance for the management of patients with vascular disease or cardiovascular risk factors and Covid-19 Position paper from VAS-European Independent Foundation in Angiology/Vascular Medicine

“…However, treatment with antiplatelet agents did not affect the mortality in ARDS patients. 110,111 Based on this rationale, 11 studies registered in ClinicalTrials.gov (https://clinicaltrials. gov/ct2/results?cond=Covid19&term=aspirin&cntry=&sta-te=&city=&dist=) investigate the effect of early initiation of aspirin treatment if it mitigates the prothrombotic state and reduces hospitalization rates in patients with nonsevere COVID-19.…”

Vitronectin promotes immunothrombotic dysregulation in the venular microvasculature

“…In this context it is interesting that first clinical data on anti-platelet treatment using a GPIIb/IIIa antagonist (tirofiban) or other anti-platelet agents including a COX inhibitor (aspirin) or ADP receptor antagonist (clopidogrel) showed protective effects in severe COVID-19 (58,59). Noteworthy, treatment with these anti-platelet compounds also attenuated the risk of developing acute respiratory distress syndrome in non-COVID-19 patients, but did not reduce their mortality (60,61), pointing to disease-specific effects of these therapeutic interventions. Consequently, blocking the VN-GPIIb/IIIa axis might be particularly beneficial in severe systemic inflammatory pathologies such as COVID-19.…”

The role of artificial neural networks in prediction of severe acute pancreatitis associated acute respiratory distress syndrome: A retrospective study

“…The mortality rates in patients with moderate and severe ARDS were 40.3% and 46.1%, respectively. [12] For patients with a high risk of ARDS, intervention measures, such as lower tidal volume ventilation and limiting fluid infusion, [13] antiplatelet therapy, [14] and nebulized heparin, [15] can significantly reduce the incidence of ARDS. However, the absence of effective methods to evaluate the risk of ARDS remains a major obstacle in improving prognosis.…”