Abstract Number: PB1402
Meeting: ISTH 2020 Congress
Theme: Platelet Disorders and von Willebrand Disease » Antiplatelet Therapy
Background: The role of platelets in hemostasis and thrombosis has long been studied. There’s growing evidence of their importance in inflammatory and immunological responses to infection.
Critically ill patients with systemic inflammation and sepsis show platelet activation. Inhibition of platelet activation has been postulated to have a beneficial effect in critically ill patients.
Aims: Evaluate the correlation of chronic acetylsalicylic acid (ASA) therapy discontinuation upon intensive care medicine department (ICMD) admission and critically ill patients’ mortality.
Methods: Retrospective, descriptive, single center cohort study performed during 2014, on a 65 bed ICMD. Adult patients with unscheduled admission through the ED and a prior record of chronic ASA therapy were included. Clinical variables at ICDM admission were extracted from the medical records. Primary outcomes were ICMD mortality and global mortality 90 days. Survival analysis and adjusted mortality with a cox regression was also calculated with a follow up time of 90 days. The study was approved by the local ethics committee with a waiver of informed consent.
Results: A total of 232 patients were included. Patient baseline characteristics can be seen in table 1. Table 2 shows the crude and Cox adjusted hazards ratio.
Patients that received ASA during ICDM had a lower crude ICMD and global mortality and a significantly lower model adjusted mortality (HR=0.391 p=0.027).
Conclusions: Upon ICMD admission, patients who have been discontinued from their chronic ASA therapy have higher crude and adjusted mortality. Some confounding variables may justify some of this difference in mortality.
Despite this, when admitting to an ICMD, the decision to suspend the patient´s chronic therapy must be carefully considered.
| Variable | No ASA n=114 | ASA n=118 | p |
| Age, years, median [IQR] | 75 [17] | 74 [17] | 0.459 |
| Gender, male n (%) | 60 (52.6) | 75 (63.6) | 0.092 |
| ICDM mortality n (%) | 23 (20.2) | 13 (11.0) | 0.054 |
| Mortality 90 days, n (%) | 30 (26.3) | 21 (17.8) | 0.125 |
| ICMD LOS, days, median [IQR] | 3 [4] | 3 [3] | 0.169 |
| qSOFA ≥2, n (%) | 42 (36.8) | 47 (39.8) | 0.640 |
| SAPSII score, median [IQR] | 39 [21] | 37 [18] | 0.753 |
| Max Lactate level, median [IQR] | 2.05 [2.55] | 1.99 [1.57] | 0.359 |
| Infection, n (%) | 31 (32.5) | 38 (32.2) | 0.967 |
[Table 1- Baseline characteristics of patients with and without ICMD ASA therapy]
| Crude HR | Adjusted HR ζ | |||||
| Variable | HR | 95% CI | p | HR | 95% CI | p |
| Age | 0.984 | 0.956-1.013 | 0.280 | 0.970 | 0.931-1.011 | 0.149 |
| Gender, male | 1.751 | 0.862-3.560 | 0.122 | 1.237 | 0.523-2.925 | 0.628 |
| ASA during ICMD | 0.520 | 0.264-1.027 | 0.060 | 0.391 | 0.170-0.898 | 0.027 |
| SAPSII score | 1.048 | 1.026-1.071 | <0.0005 | 1.039 | 1.006-1.073 | 0.021 |
| Maximum Lactate level | 1.065 | 1.006-1.127 | 0.029 | 1.030 | 0.936-1.132 | 0.546 |
| Infection | 1.072 | 0.536-2.143 | 0.845 | 1.545 | 0.682-3.498 | 0.297 |
| Unscheduled surgery | 2.494 | 1.276-4.877 | 0.008 | 1.492 | 0.628-3.546 | 0.365 |
| ζ The model included age, SAPSII score, maximum lactate level in first 24 hours, emergency department procedures (eg. central venous catheter placement, vasopressor therapy), non-programmed surgery and ICDM ASA therapy as independent variables. | ||||||
[Table 2- Hazard ratios for mortality within 90 days using Cox proportional hazards regression.]
To cite this abstract in AMA style:
Martins Pereira F, Abreu S, Mergulhão P, Paiva JA. Discontinuation of Chronic Low Dose Acetylsalicylic Acid Therapy Upon Intensive Care Medicine Department Admission Appears to Increase Mortality [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/discontinuation-of-chronic-low-dose-acetylsalicylic-acid-therapy-upon-intensive-care-medicine-department-admission-appears-to-increase-mortality/. Accessed January 21, 2022.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/discontinuation-of-chronic-low-dose-acetylsalicylic-acid-therapy-upon-intensive-care-medicine-department-admission-appears-to-increase-mortality/