From: Blood platelets and sepsis pathophysiology: A new therapeutic prospect in critical ill patients?
Authors | Study year | Study type and setting | Patient number | Antiplatelet agent | Patients | Study conclusions | Potential limitations  |
---|---|---|---|---|---|---|---|
Wang et al. [268] | 2016 | Meta analysis of cohort studies | 14,612 | ASA, clopidogrel, ticlopidine | ICU patients with ARDS predisposing conditions | Reduced mortality and lower incidence of ARDS | Non-sepsis patients included Treatment bias of antiplatelet agents |
Kor et al. [269] | 2012–2014 | Multicenter, double-blind, placebo-controlled, randomized clinical trial | 390 | ASA | Patients with elevated risk for developing ARDS in the emergency department | ASA did not reduce the risk of ARDS and 28-day or 1-year survival | Non-sepsis patients included Low rate of ARDS development |
Wiewel et al. [260] | 2011–2014 | Prospective observational study with propensity matching | 972 | Mostly ASA | Sepsis within 24 h after admission in 2 mixed medical/surgical ICU | Antiplatelet therapy was not associated with alterations in the presentation or outcome of sepsis or the host response | Treatment bias of ASA Inadequate patient number and power |
Osthoff et al. [270] | 2001–2013 | Retrospective cohort study with propensity matching | 689 | ASA | Patients with S. aureus and E. coli bloodstream infection admitted in a single medical/surgical ICU | Low-dose ASA at the time of bloodstream infection was strongly associated with a reduced short-term mortality in patients with S. aureus bloodstream infection | Treatment bias of ASA at the time of enrolment Severity at presentation was not included in the analysis model Inadequate patient number and power |
Tsai et al. [255] | 2000–2010 | A nation-wide population-based cohort and nested case–control study | 683,421 | ASA, clopidogrel, ticlopidine | Sepsis | Antiplatelet agents were associated with a survival benefit in sepsis patients | Claims database |
Chen et al. [253] | 2006–2012 | Secondary analysis of prospective cohort with propensity matching | 1149 | ASA | Patients admitted in a mixed ICU for at least 2 days | Decreased risk of ARDS | Non-sepsis patients included Treatment bias of ASA |
Boyle et al. [271] | 2010–2012 | Prospective observational study | 202 | ASA | ICU patients requiring invasive mechanical ventilation | Reduced risk of ICU mortality | Treatment bias of ASA Non-sepsis patients included |
Valerio-Rojas et al. [249] | 2007–2009 | Retrospective cohort with propensity matching | 651 | ASA, clopidogrel | ICU patients with sepsis | No decrease in hospital mortality but decreased incidence of ARDS | Inadequate patient number and power Unmeasured bias and confounding |
Otto et al. [251] | 2013 | Retrospective cohort | 886 | ASA, clopidogrel | Surgical ICU patients with sepsis and a minimum length of stay of 48Â h and a history of atherosclerotic vascular diseases | ASA treatment reduced the ICU and hospital mortality. Combination of ASA with clopidogrel did not show any significant effect on mortality. Clopidogrel alone might have a similar benefit | Unmeasured bias and confounding |
Sossdorf et al. [250] | 2013 | Retrospective cohort | 979 | ASA | Septic patients admitted to a surgical ICU | Decreased mortality with ASA or NSAIDs was associated with decreased hospital mortality. No benefit when ASA and NSAIDs are given together | Unmeasured bias and confounding |
Eisen et al. [248] | 2000–2009 | Retrospective cohort study with propensity matching | 7945 | ASA | ICU patients with SIRS/sepsis on ASA at the time of SIRS/sepsis | ASA was associated with survival | Treatment bias of ASA at the time of enrolment and confounders |
O’Neal et al. [272] | 2006–2008 | Cross-sectional analysis of a prospective cohort | 575 | ASA and Statin | Patients admitted in a mixed ICU for at least 2 days | ASA was not associated with the diagnosis of ALI/ARDS, sepsis or hospital mortality | Treatment bias of ASA Unmeasured bias and confounding Non-sepsis patients included |
Erlich et al. [246] | 2006 | Retrospective cohort | 161 | ASA, clopidogrel, ticlopidine | Adult patients admitted in a medical ICU with a major risk factor for ALI | Reduced incidence of ALI/ARDS | Treatment bias of ASA Non-sepsis patients included |
Kor et al. [256] | 2009 | Second analysis of prospective multicenter observational study | 3855 | ASA | Consecutive, adult, non-surgical patients with at least one major risk factor for ALI | ASA was not associated with ICU or hospital mortality and ICU or hospital lengths | Treatment bias of ASA Non-sepsis patients included Unmeasured bias and confounding |
Storey et al. [273] | 2006–2008 | Post hoc analysis PLATO study | 18,421 | Ticagrelor vs clopidogrel | Patients with acute coronary syndrome | Reduced mortality following pulmonary infection and sepsis in acute coronary syndrome with ticagrelor | Unmeasured bias and confounding |
Winning et al. [245] | 2007–2009 | Retrospective cohort | 615 | ASA, clopidogrel | Consecutive patients admitted in a mixed ICU | Reduction in organ failure and mortality in critically ill patients with pre-existing medication | Non-sepsis patients included Treatment bias of ASA |
Winning et al. [274] | 2002–2007 | Retrospective cohort | 224 | ASA, clopidogrel ticlopidine | Patients admitted for CAP not receiving statins and using antiplatelet drugs for more than 6 months | Reduction in need of intensive care treatment and length of hospital stay | Unmeasured bias and confounding |
Gross et al. [275] | 2001–2005 | Retrospective cohort | 417,648 | Clopidogrel | All adult (≥ 18 years) Medicaid beneficiaries in Kentucky | Increased CAP incidence and no significant reduction in severity | Claims database |