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Table 1 Summary of cohort studies on antiplatelet agents and sepsis

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 48 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

  1. ASA Acetylsalicylic acid, ARDS acute respiratory distress syndrome, ALI acute lung injury, CAP community-acquired pneumonia, NSAID non-steroidal anti-inflammatory drug