Outcomes of Severe Sepsis and Septic Shock Patients on Chronic Antiplatelet Treatment: A Historical Cohort Study

Valerio-Rojas, Juan Carlos; Jaffer, Insara J.; Kor, Daryl J.; Gajic, Ognjen; Cartin‐Ceba, Rodrigo

doi:10.1155/2013/782573

Cited by 49 publications

(83 citation statements)

References 44 publications

(45 reference statements)

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“…These results are supported from human observational studies wherein it was noted that aspirin treatment could have decreased risk of developing sepsis and ARDS; reduced severity when they do develop sepsis or ARDS and decreased mortality [5, 24–37]. But these results are not without controversy [28]. These studies are interesting and open a new avenue of managing sepsis and ARDS.…”

Section: Introductionmentioning

confidence: 68%

“…In view of this, it is unlikely that aspirin alone will be of significant benefit in ARDS and sepsis wherein AA, EPA and DHA deficiency is present. This argument is supported by the observation that administration of aspirin produced controversial results in sepsis and ARDS [28]. I propose that co-administration of PUFAs (especially AA, EPA and DHA) along with aspirin is likely to be of more beneficial and rational than administration of aspirin alone.…”

Section: Essential Fatty Acid (Efa) Metabolism Is Altered In Sepsis Amentioning

confidence: 98%

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Combination of aspirin with essential fatty acids is superior to aspirin alone to prevent or ameliorate sepsis or ARDS

Das¹

2016

Lipids Health Dis

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It has been suggested that aspirin may be of benefit in treating sepsis and ARDS in view of its ability to block cyclo-oxygenase-1 (COX-1) and COX-2 activities; inhibit nuclear factor kappa B (NF-κB); enhance the production of endothelial nitric oxide (eNO) and lipoxin A4 (LXA4). Our previous studies revealed that plasma phospholipid content of arachidonic acid (AA) and eicosapentaenoic acid (EPA) is low in patients with sepsis. This implies that beneficial actions of aspirin in sepsis and ARDS is unlikely to be obtained in view of deficiency of AA and EPA, the precursors of LXA4 and resolvins respectively that are potent anti-inflammatory compounds and enhancers of eNO generation. In view of this, I propose that a combination of aspirin and AA and EPA (and possibly, docosahexaenoic acid, DHA) is likely to be superior in the management of sepsis and ARDS compared to aspirin alone. This suggestion is supported by the recent observation that trauma patients with uncomplicated recoveries had higher resolvin pathway gene expression and lower gene expression ratios of leukotriene: resolvin pathways.

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Section: Introductionmentioning

confidence: 68%

Section: Essential Fatty Acid (Efa) Metabolism Is Altered In Sepsis Amentioning

confidence: 98%

Combination of aspirin with essential fatty acids is superior to aspirin alone to prevent or ameliorate sepsis or ARDS

Das¹

2016

Lipids Health Dis

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“…Given the high risk of mortality in this patient population, it is possible that β blocker administration confounded this result. Similarly, in a study of patients with severe sepsis,39 reduced incidence of ARDS/acute lung injury (ALI) was observed in the antiplatelet-treated group (OR 0.5, 95% CI 0.35 to 0.71, p<0.001), but no mortality benefit was demonstrated (OR 0.73, 95% CI 0.46 to 1.16), p=0.19) 39. In this investigation, APACHE III scores (55–57) are associated with an anticipated mortality of ∼15–20%, which would correlate to the ‘intermediate cTn’ group of Poe et al , a cohort that did not have an associated mortality benefit with aspirin.…”

Section: Resultsmentioning

confidence: 95%

Systematic Review of β Blocker, Aspirin, and Statin in Critically Ill Patients: Importance of Severity of Illness and Cardiac Troponin

Rothenberg

Clay²,

Jamali

et al. 2017

Journal of Investigative Medicine

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Non-cardiac critically ill patients with type II myocardial infarction (MI) have a high risk of mortality. There are no evidence-based interventions to mitigate this risk. We systematically reviewed the literature regarding the use of medications known to reduce mortality in patients with cardiac troponin (cTn) elevation due to type I MI (β blockers, statin, and aspirin) in studies of critically ill patients without Type I MI. All PubMed publications between 1976-2/19/16 were reviewed. Search terms included: β blocker or aspirin or statin and intensive care unit (ICU) or critically ill or sepsis; 497 primary references were obtained. Inclusion criteria were as follows: (1) study population consisted of critically ill patients in the ICU with non-cardiovascular illnesses, (2) mortality end point, (3) severity of illness (or injury) was measured, and (4) the antiplatelet agent was primarily aspirin. Retrospective investigations, prospective observational studies, meta-analysis, systematic review, and randomized controlled trials were included; case reports were excluded. 25 primary references were obtained. The data were extracted and tabulated using data collection headings as follows: article title, first author/year/reference number, study type/design, population studied, outcome and intervention, and study question addressed. Evidence was not graded as the majority of studies were non-randomized (low-to-moderate quality). 11 studies were found through bibliography reviews for a total of 36 references. In conclusion, β blockers, statins, and aspirin may play a role in reducing mortality in non-cardiac critically ill patients. Benefit appears to be related to severity of illness, for which cTn may be a marker.

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“…In one study, it was not possible to disaggregate aspirin use from that of other antiplatelets in the hospital-based cohort (13). However, as aspirin was the antiplatelet used by over 95% of patients in all other studies (6, 10, 16, 18), it is likely that it constituted the large majority of antiplatelet agents used in the analysis of antiplatelet exposure for this study.…”

Section: Methodsmentioning

confidence: 96%

Quantifying the Effects of Prior Acetyl-Salicylic Acid on Sepsis-Related Deaths: An Individual Patient Data Meta-Analysis Using Propensity Matching*

Trauer

Muhi

McBryde

et al. 2017

Critical Care Medicine

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Objective The primary objective was to conduct a meta-analysis on published observational cohort data describing the association between acetyl-salicylic acid (aspirin) use prior to the onset of sepsis and mortality in hospitalized patients. Study Selection Studies which reported mortality in patients on aspirin with sepsis with a comparison group of patients with sepsis not on prior aspirin therapy were included. Data sources Fifteen studies described hospital-based cohorts (n=17,065), while one was a large insurance-based database (n=683,421). Individual-level patient data were incorporated from all selected studies. Data Extraction Propensity analyses with 1:1 propensity score matching at the study level were performed, using the most consistently available covariates judged to be associated with aspirin. Meta-analyses were performed to estimate the pooled average treatment effect of aspirin on sepsis-related mortality. Data Synthesis Use of aspirin was associated with a 7% (95%CI, 2% to 12%, p=0.005) reduction in the risk of death as shown by meta-analysis with considerable statistical heterogeneity (I2=61.6%). Conclusions These results are consistent with effects ranging from a 2% to 12% reduction in mortality risk in patients taking aspirin prior to sepsis onset. This association anticipates results of definitive studies of the use of low-dose aspirin as a strategy for reduction of deaths in patients with sepsis.

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Outcomes of Severe Sepsis and Septic Shock Patients on Chronic Antiplatelet Treatment: A Historical Cohort Study

Cited by 49 publications

References 44 publications

Combination of aspirin with essential fatty acids is superior to aspirin alone to prevent or ameliorate sepsis or ARDS

Combination of aspirin with essential fatty acids is superior to aspirin alone to prevent or ameliorate sepsis or ARDS

Systematic Review of β Blocker, Aspirin, and Statin in Critically Ill Patients: Importance of Severity of Illness and Cardiac Troponin

Quantifying the Effects of Prior Acetyl-Salicylic Acid on Sepsis-Related Deaths: An Individual Patient Data Meta-Analysis Using Propensity Matching*

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