Antiplatelet Therapy And Disseminated Intravascular Coagulation In Septic Shock Patients: Propensity Score Analysis

Cartin‐Ceba, Rodrigo; Valerio-Rojas, Juan Carlos; Cabello-Garza, Javier; Kelm, Diana J.; Gajić, Ognjen

doi:10.1164/ajrccm-conference.2011.183.1_meetingabstracts.a4698

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“…1 Saint Barnabas Medical Center -Department of Pharmacy, Livingston, NJ, USA 2 Rutgers University -Ernest Mario School of Pharmacy, Piscataway, NJ, USA Cartin-Ceba and colleagues published a retrospective observational cohort study of 390 adult patients with septic shock which demonstrated that antiplatelet use was associated with decreased risk of DIC (odds ratio .23; 95% CI 0.10-.50) after adjusting for the probability of antiplatelet adherence, severity of illness, age, positive blood cultures, timely antibiotics, and adequate resuscitation. 7 Similarly, a second retrospective cohort study by Valerio-Rojas and colleagues of 651 patients with severe sepsis or septic shock demonstrated that chronic antiplatelet therapy was associated with both a decreased incidence of acute respiratory distress syndrome (ARDS) (odds ratio .50; 95% CI 0.35-.71; P < .001) and a decreased need for mechanical ventilation (odds ratio .62; 95% CI 0.45-.87; P = .005). 8 However, this study did not associate antiplatelet use with decreased mortality (odds ratio .73; 95% CI 0.46-1.16; P = .…”

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Evaluation of Hospitalized Patient Outcomes in COVID-19 Infection for Continued versus Discontinued Use of Preadmission Antiplatelet Regimen

Antoniello

Brophy

Opsha

2021

Journal of Pharmacy Practice

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Objective In SARS-CoV-2 (COVID-19) infection, it is unclear if continuation of preadmission antiplatelet regimens upon hospitalization will improve hypercoagulability outcomes. Methods This retrospective cohort study analyzed adult patients hospitalized with confirmed COVID-19 infection for a 6-week period from March 13, 2020, to April 27, 2020. Preadmission antiplatelet regimen continuation for less than 75% of admission was compared to continuation for at least 75% of admission. Pregnancy, either death or withdrawal of care within 24 hours of admission, and admission beyond the studied timeframe were excluded. The primary endpoint was difference in World Health Organization COVID-19 Ordinal Scale for Clinical Improvement values (World Health Organization [WHO] scores) between maximum score during admission to that upon discharge. Secondary endpoints were mechanical ventilation requirement, mortality, radiologically confirmed venous thromboembolism, major bleeding, and length of stay. Results This study included 171 patients. Patients failing to continue antiplatelet regimens for at least 75% of admission (n = 76) had significantly worse WHO score differences than those who did (n = 95) (median −1 vs 2; P < .05). Mechanical ventilation requirement (57% vs 27%; P < .05) and mortality (58% vs 29%; P < .05) also favored antiplatelet continuation. All other endpoints were not significantly different. Conclusion Significantly improved WHO scores, mechanical ventilation requirement, and mortality occurred in patients continuing preadmission antiplatelet regimens in COVID-19 infection. Future prospective studies of COVID-19 patients with consistently collected baseline hypercoagulability markers (platelets, D-dimer, fibrinogen, and coagulation studies) and similar severe disease risk factors are required to confirm potential benefits of antiplatelet therapy during hospitalization.

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