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Antiplatelets Improve Survival Among Critically Ill Mechanically Ventilated Patients FREE TO VIEW

Paola Faverio; Stefano Aliberti; Luis Reyes; Oriol Sibila, MD; Carlos Orihuela; Armand Brown; Antonio Anzueto; James Chalmers; Marcos Restrepo
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University of Texas Health Science Center at San Antonio, San Antonio, TX

Chest. 2014;146(4_MeetingAbstracts):500A. doi:10.1378/chest.1995211
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SESSION TITLE: Outcomes/Quality Control Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Antiplatelets including acetyl salicylic acid and clopidogrel have been shown to be anti-inflammatory in human studies. Antiplatelet therapy may potentially benefit patients with sepsis, pneumonia and acute lung injury. However, limited data are available regarding antiplatelet therapy in critically ill patients. Our aim was to determine whether antiplatelet therapy as an outpatient and during hospital admission is associated with reduced mortality among critically ill mechanically ventilated patients.

METHODS: Retrospective cohort study of critically ill mechanically ventilated patients for 1 day or more managed at a tertiary medical intensive care unit between January 1 to December 31, 2008. We stratified patients according to the severity of illness with an APACHE II score of 25 or higher. Exposure to antiplatelet therapy included aspirin and clopidogrel at the time of hospital presentation and during hospitalization. The primary outcome was mortality during ICU and hospital stay. We used a Chi-square and a Student t-test to compare categorical and continuous variables accordingly.

RESULTS: Among 150 critically ill mechanically ventilated patients, 36% were on antiplatelets at the time of admission and 16% during the hospitalization. All cause ICU and hospital mortality was 50% and 56%, respectively. Chronic antiplatelet therapy was associated with lower ICU mortality, but not hospital mortality when compared to no-antiplatelet therapy (25% vs. 75%, p=.006 and 42% vs. 59%, p=.03). In addition, antiplatelet therapy administered during the hospitalization was associated with lower ICU (25% vs. 55%, p=.008) and hospital mortality 25% vs. 55%, p=.03, respectively.

CONCLUSIONS: Our study suggests a protective survival effect of antiplatelets in mechanically ventilated critically ill patients.

CLINICAL IMPLICATIONS: Further prospective and randomized controlled trials are needed to assess the efficacy of antiplatelet therapy in critically ill patients.

DISCLOSURE: The following authors have nothing to disclose: Paola Faverio, Stefano Aliberti, Luis Reyes, Oriol Sibila, Carlos Orihuela, Armand Brown, Antonio Anzueto, James Chalmers, Marcos Restrepo

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