Prehospital Aspirin Use Is Associated With Reduced Risk of Acute Respiratory Distress Syndrome in Critically Ill Patients

Abstract

Objectives Platelet activation plays an active role in the pathogenesis of acute respiratory distress syndrome (ARDS). In our prior study of 575 patients at high risk for ARDS, concurrent statin and aspirin use was associated with reduced ARDS. However, the largest study (n=3855) to date found no significant benefit of prehospital aspirin in a lower risk population when adjusted for the propensity for aspirin use. We aimed to determine whether prehospital aspirin use is associated with decreased ARDS in patients at high risk for ARDS after adjusting for the propensity to receive aspirin. Design Secondary analysis of patients enrolled prospectively in the Validating Acute Lung Injury Markers for Diagnosis (VALID) study. Patients A total of 1149 critically ill patients (age ≥ 40) admitted to the medical or surgical intensive care units of an academic tertiary care hospital including 575 previously reported patients as well as additional patients who were enrolled after completion of the prior statin and aspirin study. Intervention None Measurements and Results Of 1149 patients, 368 (32%) developed ARDS during the first four ICU days and 287 (25%) patients had prehospital aspirin use. Patients with prehospital aspirin had significantly lower incidence of ARDS (27% vs. 34%, p=0.034). In a multivariable, propensity-adjusted analysis including age, gender, race, sepsis and APACHE II, prehospital aspirin use was associated with a decreased risk of ARDS (OR 0.66, 95% CI 0.46-0.94) in the entire cohort and in a subgroup of 725 patients with sepsis (OR 0.60, 95% CI 0.41-0.90). Conclusions In this selected cohort of critically ill patients, prehospital aspirin use was independently associated with a decreased risk of ARDS even after adjusting for the propensity of pre-hospital aspirin use. These findings support the need for prospective clinical trials to determine whether aspirin may be beneficial for the prevention of clinical ARDS.

Early identification of patients at risk for acute respiratory distress syndrome among severe pneumonia: a retrospective cohort study

“…For high risk of ARDS, preventive strategies may be required such as protective MV optimization (low tidal volume, high PEEP), restrictive transfusion, sepsis management, as well as conservative fluid strategy (29). Furthermore, some novel treatments are now under investigations but they are all based on early recognition of ARDS, such as prehospital use of inhaled steroids, aspirin, or heparin (30)(31)(32). Our study about the risk factors for ARDS development in severe pneumonia further enriches and highlights the limited knowledge in such an area and is of clinical importance and practice.…”

Acute respiratory distress syndrome

“…As such, the opportunity for ARDS prevention is constrained in a small window of time [31]. Some observational studies and experimental data suggested a potential preventive role of antiplatelet therapy in patients at high risk of ARDS [32][33][34]. As ARDS pathogenesis includes a series of dysregulated mechanisms (e.g.…”

Immunothrombosis in Acute Respiratory Distress Syndrome: Cross Talks between Inflammation and Coagulation

“…There are several very recent human studies concerning the antiplatelet therapy in ARDS. Regarding the prevention of ARDS, the administration of antiplatelet treatment in patients with at least one risk factor led to a reduced incidence of the syndrome [131] . However, these results were not confirmed in a larger trial studying the prehospital administration of aspirin, which showed only a trend towards reduced occurrence of the syndrome [132] .…”