The association of antiplatelet agents with mortality among patients with non–COVID-19 community-acquired pneumonia: a systematic review and meta-analysis

Sylvain A. Lother; Lana Tennenhouse; Rasheda Rabbani; Ahmed M. Abou-Setta; Nicole Askin; Alexis F. Turgeon; Srinivas Murthy; Brett L. Houston; Donald S. Houston; Asher A. Mendelson; Jonathan D. Paul; Michael E. Farkouh; Jovan Hasmatali; Barret Rush; Joel Nkosi; Ewan C. Goligher; Emily Rimmer; John C. Marshall; Souradet Y. Shaw; Patrick R. Lawler; Yoav Keynan; Ryan Zarychanski

Research and Practice in Thrombosis and Haemostasis (Jul 2024)

The association of antiplatelet agents with mortality among patients with non–COVID-19 community-acquired pneumonia: a systematic review and meta-analysis

Sylvain A. Lother,
Lana Tennenhouse,
Rasheda Rabbani,
Ahmed M. Abou-Setta,
Nicole Askin,
Alexis F. Turgeon,
Srinivas Murthy,
Brett L. Houston,
Donald S. Houston,
Asher A. Mendelson,
Jonathan D. Paul,
Michael E. Farkouh,
Jovan Hasmatali,
Barret Rush,
Joel Nkosi,
Ewan C. Goligher,
Emily Rimmer,
John C. Marshall,
Souradet Y. Shaw,
Patrick R. Lawler,
Yoav Keynan,
Ryan Zarychanski

Affiliations

Sylvain A. Lother: Section of Infectious Diseases, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Section of Critical Care, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Correspondence Sylvain A. Lother, University of Manitoba, Health Sciences Center, GC 436, 820 Sherbrook St, Winnipeg, MB R3A1R9, Canada.
Lana Tennenhouse: Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
Rasheda Rabbani: George & Fay Yee Centre for Healthcare Innovation, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
Ahmed M. Abou-Setta: George & Fay Yee Centre for Healthcare Innovation, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
Nicole Askin: Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada
Alexis F. Turgeon: Department of Anesthesiology and Critical Care, Université Laval, Quebec City, Quebec, Canada; Population Health and Optimal Health Practices Research Unit, Departments of Traumatology, Emergency Medicine, and Critical Care Medicine, Université Laval Research Center, Centre Hospitalier Universitaire de Quebec-Université Laval, Quebec City, Quebec, Canada
Srinivas Murthy: Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
Brett L. Houston: Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Section of Hematology and Medical Oncology, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
Donald S. Houston: Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Section of Hematology and Medical Oncology, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
Asher A. Mendelson: Section of Critical Care, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
Jonathan D. Paul: Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
Michael E. Farkouh: Department of Cardiology, Cedars-Sinai Health System, Los Angeles, California, USA
Jovan Hasmatali: Section of Critical Care, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
Barret Rush: Section of Critical Care, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
Joel Nkosi: Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
Ewan C. Goligher: Interdepartmental Division of Critical Care Medicine, and the Department of Medicine and Physiology, University of Toronto, Toronto, Ontario, Canada
Emily Rimmer: Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Section of Hematology and Medical Oncology, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
John C. Marshall: Departments of Surgery and Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
Souradet Y. Shaw: Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
Patrick R. Lawler: Divison of Cardiology and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, McGill University Health Centre and McGill University, Montreal, Quebec, Canada
Yoav Keynan: Section of Infectious Diseases, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
Ryan Zarychanski: Section of Critical Care, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Medical Oncology and Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada; Section of Hematology and Medical Oncology, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada

Journal volume & issue: Vol. 8, no. 5
p. 102526

Abstract

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Background: Community-acquired pneumonia (CAP) triggers inflammatory and thrombotic host responses driving morbidity and mortality. Antiplatelet agents may favorably modulate these pathways; however, their role in non–COVID-19 CAP remains uncertain. Objectives: To evaluate the association of antiplatelet agents with mortality in hospitalized patients with non–COVID-19 CAP. Methods: We conducted a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs) of adult patients hospitalized for non–COVID-19 CAP exposed to antiplatelet agents (acetylsalicylic acid or P2Y12 inhibitors). We searched MEDLINE, Embase, and CENTRAL from inception to August 2023. Our primary outcome was all-cause mortality: meta-analyzed (random-effects models) separately for observational studies and RCTs. For observational studies, we used adjusted mortality estimates. Results: We included 13 observational studies (123,012 patients; 6 reported adjusted mortality estimates) and 2 RCTs (225 patients; both high risk of bias). In observational studies reporting hazard ratio, antiplatelet agents were associated with lower mortality (hazard ratio, 0.65; 95% CI, 0.46-0.91; I2 = 85%; 4 studies, 91,430 patients). In studies reporting adjusted odds ratio, antiplatelet agent exposure was associated with reduced odds of mortality (odds ratio, 0.67; 95% CI, 0.45-1.00; I2 = 0%; 2 studies, 24,889 patients). Among RCTs, there was a nonsignificant association with mortality (risk ratio, 0.66; 95% CI, 0.20-2.25; I2 = 54%; 2 studies, 225 patients). By the Grading of Recommendations, Assessment, Development, and Evaluation criteria, the certainty of the evidence was low, primarily due to risk of bias. Conclusion: In hospitalized patients with non–COVID-19 CAP, antiplatelet agents may be associated with reduced mortality compared with usual care or placebo, but the certainty of evidence is low.

Published in Research and Practice in Thrombosis and Haemostasis

ISSN: 2475-0379 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the blood and blood-forming organs
Website: https://www.sciencedirect.com/journal/research-and-practice-in-thrombosis-and-haemostasis

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