The effect of pre-hospital anti-platelet therapy in adults with ARDS: A meta-analysis

Abstract

Introduction Anti-platelet agents have the potential to play a role in the treatment or prevention for acute respiratory distress syndrome (ARDS).

Aims and objectives We conducted a meta-analysis to assess the effect of pre-hospital anti-platelet therapy (APT) in adults with ARDS.

Methods We searched the PubMed, Web of Science, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. All human studies published in full text, abstract, or poster form were eligible for inclusion. We included prospectively or respectively cohort, case control trials or RCT. We included trials comparing the incidence of ARDS in patients with pre-hospital anti-platelet agents or not. The primary outcome was ARDS morbidity, while secondary outcome was ICU mortality.

Results We indentified 8 studies meeting the eligibility criteria (seven cohorts, one case control). Meta-analysis of 7 studies of 30291 patients showed that pre-hospital APT was associated with a decrease in the odds of ARDS compared with those without APT (OR 0.68, 95% CI 0.56 - 0.83, p=0.0001). Of these studies, three calculated the ICU mortality, showing a 5.58% in the pre-hospital APT users and 5.66% in the nonusers (OR 0.84, 95% CI 0.63 - 1.11, P = 0.22, I² = 0%).

Conclusions Clinical studies reviewed here have provided some evidence that pre-hospital APT significantly reduce ARDS rate, but not mortality in critically ill patients, compared to that in APT nonusers. The findings suggested an early use of anti-platelet agents would be beneficial in critical care patients at risk of ARDS.