Use of Antiplatelet Agents and Survival of Tuberculosis Patients: A Population-Based Cohort Study

Abstract

While evidence is accumulating that platelets contribute to tissue destruction in tuberculosis (TB) disease, it is still not known whether antiplatelet agents are beneficial to TB patients. We performed this retrospective cohort study and identified incident TB cases in the Taiwan National Tuberculosis Registry from 2008 to 2014. These cases were further classified into antiplatelet users and non-users according to the use of antiplatelet agents prior to the TB diagnosis, and the cohorts were matched using propensity scores (PSs). The primary outcome was survival after a TB diagnosis. In total, 74,753 incident TB cases were recruited; 9497 (12.7%) were antiplatelet users, and 7764 (10.4%) were aspirin (ASA) users. A 1:1 PS-matched cohort with 8864 antiplatelet agent users and 8864 non-users was created. After PS matching, antiplatelet use remained associated with a longer survival (adjusted hazard ratio (HR): 0.91, 95% confidence interval (CI): 0.88–0.95, p < 0.0001). The risk of major bleeding was not elevated in antiplatelet users compared to non-users (p = 0.604). This study shows that use of antiplatelet agents has been associated with improved survival in TB patients. The immunomodulatory and anti-inflammatory effects of antiplatelet agents in TB disease warrant further investigation. Antiplatelets are promising as an adjunct anti-TB therapy.

Host‐directed therapy to combat mycobacterial infections*

“…187 Furthermore, COX inhibitors ibuprofen and aspirin administered as single therapy or combined with conventional TB antibiotics were shown to limit bacterial burden in Mtb-infected mice, [192][193][194] and low-dose aspirin treatment also reduced bacterial loads in a Mm zebrafish infection model. 195 Aspirin treatment of TB or TB meningitis patients improved survival, 196,197 but may impair conventional treatment regimens by reducing efficacy of isoniazid, 198 but not pyrazinamide. 193 Both ibuprofen and aspirin are currently tested in clinical trials as adjunct therapy for treating (drug-resistant) TB.…”

Platelet Activation and the Immune Response to Tuberculosis

“…More recently, a Taiwanese population-based study of patients with drug-sensitive TB found that use of antiplatelet drugs was associated with significantly improved overall survival and a lower 12-month mortality rate, as well as lower rates of smear positivity and fewer cavities. Benefits were greater with aspirin compared to non-aspirin anti-platelet agents such as clopidogrel ( 122 ). In a randomized controlled trial, giving 100mg aspirin to diabetic patients with pulmonary TB resulted in decreased secretion of inflammatory mediators including ESR and CRP, a higher sputum-negative conversion rate (87% versus 54%), and fewer and smaller cavities following treatment, compared to placebo-treated control patients ( 123 ).…”

Survival After Treatable Hepatocellular Carcinoma Recurrence in Liver Recipients: A Nationwide Cohort Analysis

“…Demographic information, namely sex, age, monthly income, transplantation period, liver cirrhosis, and underlying comorbidity (such as diabetes mellitus, hyperlipidemia, and alcohol use), was collected, as described previously ( 22 ). Viral status, including HBV or HCV, was defined based on the prescription of antiviral medications, at least two outpatient coding, or at least one inpatient coding of the corresponding viral diagnosis within 1 year before transplantation.…”