Prior Antiplatelet Therapy and Stroke Risk in Critically Ill Patients Undergoing Extracorporeal Membrane Oxygenation
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Ethical Statement
2.2. NHIS Database and Study Population
2.3. Exposure (Aspirin and Clopidogrel Use)
2.4. Endpoints (Stroke)
2.5. Confounders
2.6. Statistical Analysis
3. Results
3.1. Study Population
3.2. Incidence of Stroke in the Entire Cohort
3.3. Subgroup Analyses According to Main Diagnosis at ECMO Therapy
3.4. Sensitivity Analysis after PS Matching
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Gattinoni, L.; Carlesso, E.; Langer, T. Clinical review: Extracorporeal membrane oxygenation. Crit. Care 2011, 15, 243. [Google Scholar] [CrossRef] [Green Version]
- Combes, A.; Hajage, D.; Capellier, G.; Demoule, A.; Lavoue, S.; Guervilly, C.; Da Silva, D.; Zafrani, L.; Tirot, P.; Veber, B.; et al. Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome. N. Engl. J. Med. 2018, 378, 1965–1975. [Google Scholar] [CrossRef]
- Lafc, G.; Budak, A.B.; Yener, A.U.; Cicek, O.F. Use of extracorporeal membrane oxygenation in adults. Heart Lung Circ. 2014, 23, 10–23. [Google Scholar] [CrossRef] [PubMed]
- Tramm, R.; Ilic, D.; Davies, A.R.; Pellegrino, V.A.; Romero, L.; Hodgson, C. Extracorporeal membrane oxygenation for critically ill adults. Cochrane Database Syst. Rev. 2015, 1, CD010381. [Google Scholar] [CrossRef]
- Eckman, P.M.; Katz, J.N.; El Banayosy, A.; Bohula, E.A.; Sun, B.; van Diepen, S. Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock: An Introduction for the Busy Clinician. Circulation 2019, 140, 2019–2037. [Google Scholar] [CrossRef] [PubMed]
- Brodie, D.; Slutsky, A.S.; Combes, A. Extracorporeal Life Support for Adults with Respiratory Failure and Related Indications: A Review. JAMA 2019, 322, 557–568. [Google Scholar] [CrossRef]
- Aneman, A.; Brechot, N.; Brodie, D.; Colreavy, F.; Fraser, J.; Gomersall, C.; McCanny, P.; Moller-Sorensen, P.H.; Takala, J.; Valchanov, K.; et al. Advances in critical care management of patients undergoing cardiac surgery. Intensive Care Med. 2018, 44, 799–810. [Google Scholar] [CrossRef]
- Cho, H.W.; Song, I.A.; Oh, T.K. Trends in extracorporeal membrane oxygenation treatment from 2005 to 2018 in South Korea. Perfusion 2021, 2676591211018130. [Google Scholar] [CrossRef] [PubMed]
- Murphy, D.A.; Hockings, L.E.; Andrews, R.K.; Aubron, C.; Gardiner, E.E.; Pellegrino, V.A.; Davis, A.K. Extracorporeal membrane oxygenation-hemostatic complications. Transfus. Med. Rev. 2015, 29, 90–101. [Google Scholar] [CrossRef]
- Parzy, G.; Daviet, F.; Puech, B.; Sylvestre, A.; Guervilly, C.; Porto, A.; Hraiech, S.; Chaumoitre, K.; Papazian, L.; Forel, J.M. Venous Thromboembolism Events Following Venovenous Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Syndrome Coronavirus 2 Based on CT Scans. Crit. Care Med. 2020, 48, e971–e975. [Google Scholar] [CrossRef]
- McCarthy, F.H.; McDermott, K.M.; Kini, V.; Gutsche, J.T.; Wald, J.W.; Xie, D.; Szeto, W.Y.; Bermudez, C.A.; Atluri, P.; Acker, M.A.; et al. Trends in U.S. Extracorporeal Membrane Oxygenation Use and Outcomes: 2002–2012. Semin. Thorac. Cardiovasc. Surg. 2015, 27, 81–88. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Millar, J.E.; Fanning, J.P.; McDonald, C.I.; McAuley, D.F.; Fraser, J.F. The inflammatory response to extracorporeal membrane oxygenation (ECMO): A review of the pathophysiology. Crit. Care 2016, 20, 387. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Le Guennec, L.; Cholet, C.; Huang, F.; Schmidt, M.; Brechot, N.; Hekimian, G.; Besset, S.; Lebreton, G.; Nieszkowska, A.; Leprince, P.; et al. Ischemic and hemorrhagic brain injury during venoarterial-extracorporeal membrane oxygenation. Ann. Intensive Care 2018, 8, 129. [Google Scholar] [CrossRef] [Green Version]
- Omar, H.R.; Mirsaeidi, M.; Shumac, J.; Enten, G.; Mangar, D.; Camporesi, E.M. Incidence and predictors of ischemic cerebrovascular stroke among patients on extracorporeal membrane oxygenation support. J. Crit. Care 2016, 32, 48–51. [Google Scholar] [CrossRef]
- Saeed, O.; Jakobleff, W.A.; Forest, S.J.; Chinnadurai, T.; Mellas, N.; Rangasamy, S.; Xia, Y.; Madan, S.; Acharya, P.; Algodi, M.; et al. Hemolysis and Nonhemorrhagic Stroke during Venoarterial Extracorporeal Membrane Oxygenation. Ann. Thorac. Surg. 2019, 108, 756–763. [Google Scholar] [CrossRef] [PubMed]
- Aubron, C.; DePuydt, J.; Belon, F.; Bailey, M.; Schmidt, M.; Sheldrake, J.; Murphy, D.; Scheinkestel, C.; Cooper, D.J.; Capellier, G.; et al. Predictive factors of bleeding events in adults undergoing extracorporeal membrane oxygenation. Ann. Intensive Care 2016, 6, 97. [Google Scholar] [CrossRef] [Green Version]
- Xie, A.; Lo, P.; Yan, T.D.; Forrest, P. Neurologic Complications of Extracorporeal Membrane Oxygenation: A Review. J. Cardiothorac. Vasc. Anesth. 2017, 31, 1836–1846. [Google Scholar] [CrossRef]
- Tendera, M.; Wojakowski, W. Role of antiplatelet drugs in the prevention of cardiovascular events. Thromb. Res. 2003, 110, 355–359. [Google Scholar] [CrossRef]
- Oprea, A.D.; Popescu, W.M. Perioperative management of antiplatelet therapy. Br. J. Anaesth. 2013, 111 (Suppl. 1), i3–i17. [Google Scholar] [CrossRef] [Green Version]
- Von Elm, E.; Altman, D.G.; Egger, M.; Pocock, S.J.; Gotzsche, P.C.; Vandenbroucke, J.P.; Initiative, S. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. Int. J. Surg. 2014, 12, 1495–1499. [Google Scholar] [CrossRef] [Green Version]
- Barbaro, R.P.; Odetola, F.O.; Kidwell, K.M.; Paden, M.L.; Bartlett, R.H.; Davis, M.M.; Annich, G.M. Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality. Analysis of the extracorporeal life support organization registry. Am. J. Respir. Crit. Care Med. 2015, 191, 894–901. [Google Scholar] [CrossRef] [Green Version]
- Rosenbaum, P.R.; Rubin, D.B. The central role of the propensity score in observational studies for causal effects. Biometrika 1983, 70, 41–55. [Google Scholar] [CrossRef]
- Malfertheiner, M.V.; Koch, A.; Fisser, C.; Millar, J.E.; Maier, L.S.; Zeman, F.; Poschenrieder, F.; Lubnow, M.; Philipp, A.; Muller, T. Incidence of early intra-cranial bleeding and ischaemia in adult veno-arterial extracorporeal membrane oxygenation and extracorporeal cardiopulmonary resuscitation patients: A retrospective analysis of risk factors. Perfusion 2020, 35, 8–17. [Google Scholar] [CrossRef]
- Fletcher-Sandersjoo, A.; Bartek, J., Jr.; Thelin, E.P.; Eriksson, A.; Elmi-Terander, A.; Broman, M.; Bellander, B.M. Predictors of intracranial hemorrhage in adult patients on extracorporeal membrane oxygenation: An observational cohort study. J. Intensive Care 2017, 5, 27. [Google Scholar] [CrossRef] [Green Version]
- Kasirajan, V.; Smedira, N.G.; McCarthy, J.F.; Casselman, F.; Boparai, N.; McCarthy, P.M. Risk factors for intracranial hemorrhage in adults on extracorporeal membrane oxygenation. Eur. J. Cardiothorac. Surg. 1999, 15, 508–514. [Google Scholar] [CrossRef]
- Koster, A.; Ljajikj, E.; Faraoni, D. Traditional and non-traditional anticoagulation management during extracorporeal membrane oxygenation. Ann. Cardiothorac. Surg. 2019, 8, 129–136. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Cheng, W.; Ma, X.D.; Su, L.X.; He, H.W.; Wang, L.; Tang, B.; Du, W.; Zhou, Y.K.; Wang, H.; Cui, N.; et al. Cross-sectional study for the clinical application of extracorporeal membrane oxygenation in Mainland China, 2018. Crit. Care 2020, 24, 554. [Google Scholar] [CrossRef]
- Schmidt, M.; Hajage, D.; Lebreton, G.; Monsel, A.; Voiriot, G.; Levy, D.; Baron, E.; Beurton, A.; Chommeloux, J.; Meng, P.; et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: A retrospective cohort study. Lancet Respir. Med. 2020, 8, 1121–1131. [Google Scholar] [CrossRef]
- Iacobelli, R.; Fletcher-Sandersjoo, A.; Lindblad, C.; Keselman, B.; Thelin, E.P.; Broman, L.M. Predictors of brain infarction in adult patients on extracorporeal membrane oxygenation: An observational cohort study. Sci. Rep. 2021, 11, 3809. [Google Scholar] [CrossRef]
- Shrestha, S.; Coy, S.; Bekelis, K. Oral Antiplatelet and Anticoagulant Agents in the Prevention and Management of Ischemic Stroke. Curr. Pharm. Des. 2017, 23, 1377–1391. [Google Scholar] [CrossRef]
- Geisler, T.; Poli, S.; Meisner, C.; Schreieck, J.; Zuern, C.S.; Nagele, T.; Brachmann, J.; Jung, W.; Gahn, G.; Schmid, E.; et al. Apixaban for treatment of embolic stroke of undetermined source (ATTICUS randomized trial): Rationale and study design. Int. J. Stroke 2017, 12, 985–990. [Google Scholar] [CrossRef] [PubMed]
- Serebruany, V.L.; Malinin, A.I.; Eisert, R.M.; Sane, D.C. Risk of bleeding complications with antiplatelet agents: Meta-analysis of 338,191 patients enrolled in 50 randomized controlled trials. Am. J. Hematol. 2004, 75, 40–47. [Google Scholar] [CrossRef] [PubMed]
- Luyt, C.-E.; Bréchot, N.; Demondion, P.; Jovanovic, T.; Hékimian, G.; Lebreton, G.; Nieszkowska, A.; Schmidt, M.; Trouillet, J.-L.; Leprince, P.J.I.c.m. Brain injury during venovenous extracorporeal membrane oxygenation. Intensive Care Med. 2016, 42, 897–907. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Chen, C.; Wang, X.; Chen, X.; Ouyang, M.; Sun, L.; Arima, H.; Robinson, T.; Lindley, R.I.; Chalmers, J.; Li, G. Disparities between Asian and Non-Asian Thrombolyzed Acute Ischemic Stroke Patients in the Enhanced Control of Hypertension and Thrombolysis Stroke Trial. Cerebrovasc. Dis. 2021, 1–7. [Google Scholar] [CrossRef]
Variable | Number (%) | Mean (SD) |
---|---|---|
Age, year | 59.5 (15.0) | |
Sex, male | 11,474 (66.6) | |
Residence at ECMO therapy | ||
Capital city (Seoul) | 3998 (23.2) | |
Other metropolitan city | 4004 (23.2) | |
Other area | 9235 (53.6) | |
Year of ECMO therapy | ||
2009–2010 | 1568 (9.1) | |
2011–2012 | 2736 (15.9) | |
2013–2014 | 3763 (21.8) | |
2015–2016 | 4234 (24.6) | |
2017–2018 | 4936 (28.6) | |
Annual income level at ECMO therapy | ||
Q1 (Lowest) | 4318 (25.1) | |
Q2 | 3142 (18.2) | |
Q3 | 3954 (22.9) | |
Q4 (Highest) | 5823 (33.8) | |
Annual case volume of ECMO therapy | ||
Q1: <17 | 4472 (25.9) | |
Q2: 17–36 | 4650 (27.0) | |
Q3: 37–80 | 4725 (27.4) | |
Q4: >81 | 3390 (19.7) | |
Length of hospital stay, day | 17.2 (15.9) | |
Duration of ECMO therapy, day | 6.2 (8.8) | |
Prior anti-PLT use | 3909 (22.7) | |
Prior NOAC use | 268 (1.6) | |
Prior statin use | 3792 (22.0) | |
Prior warfarin use | 206 (1.2) | |
LMWH use during hospitalization | 1363 (7.9) | |
Charlson comorbidity index | 4.1 (2.9) | |
Hypertension, complicated | 2481 (14.4) | |
Hypertension, uncomplicated | 11,364 (65.9) | |
Myocardial infarction | 5893 (34.2) | |
Congestive heart failure | 7012 (40.7) | |
Peripheral vascular disease | 3635 (21.1) | |
Cerebrovascular disease | 3281 (19.0) | |
Dementia | 728 (4.2) | |
Chronic pulmonary disease | 7075 (41.0) | |
Rheumatic disease | 1150 (6.7) | |
Peptic ulcer disease | 5326 (30.9) | |
Mild liver disease | 6054 (35.1) | |
Diabetes without chronic complication | 8205 (47.6) | |
Diabetes with chronic complication | 2592 (15.0) | |
Hemiplegia or paraplegia | 416 (2.4) | |
Renal disease | 1759 (10.2) | |
Any malignancy | 3083 (17.9) | |
Moderate or severe liver disease | 1208 (7.0) | |
Metastatic solid tumor | 597 (3.5) | |
AIDS/HIV | 28 (0.2) | |
Dyslipidemia | 8355 (48.5) | |
Main diagnosis at ECMO therapy | ||
Cardiovascular group | 11,029 (64.0) | |
Respiratory group | 2003 (11.6) | |
Other group | 4205 (24.4) |
Variable | Multivariable Model | p-Value |
---|---|---|
Odds Ratio (95% CI) | ||
Anti-PLT group for total stroke (vs. control; model 1) | 0.67 (0.55, 0.82) | <0.001 |
Anti-PLT group for ischemic stroke (vs. control; model 2) | 0.73 (0.55, 0.92) | 0.004 |
Anti-PLT group for hemorrhagic stroke (vs. control; model 3) | 0.56 (0.40, 0.80) | 0.001 |
Subgroup analysis for total stroke (model 4) | ||
Control (n = 13,328) | 1 | |
Aspirin monotherapy (n = 2375) | 0.75 (0.59, 0.97) | 0.025 |
Clopidogrel monotherapy (n = 588) | 0.55 (0.45, 0.80) | 0.004 |
Dual anti-PLT therapy (n = 946) | 0.63 (0.44, 0.88) | 0.007 |
Other covariates in model 1 | ||
Age, year | 0.98 (0.97, 0.98) | <0.001 |
Sex, male (vs. female) | 0.96 (0.80, 1.13) | 0.631 |
Residence at ECMO therapy | ||
Capital city (Seoul) | 1 | |
Other metropolitan city | 0.85 (0.65, 1.12) | 0.264 |
Other area | 0.96 (0.79, 1.18) | 0.706 |
Year of ECMO therapy | ||
2009–2010 | 1 | |
2011–2012 | 0.97 (0.70, 1.31) | 0.778 |
2013–2014 | 0.90 (0.66, 1.24) | 0.425 |
2015–2016 | 0.98 (0.73, 1.35) | 0.9154 |
2017–2018 | 1.25 (0.92, 1.70) | 0.180 |
Annual income level at ECMO therapy | ||
Q1 (Lowest) | 1 | |
Q2 | 1.11 (0.84, 1.42) | 0.477 |
Q3 | 1.13 (0.90, 1.44) | 0.271 |
Q4 (Highest) | 0.96 (0.78, 1.18) | 0.669 |
Annual case volume of ECMO therapy | ||
Q1: <17 | 1 | |
Q2: 17–36 | 1.28 (1.02, 1.58) | 0.030 |
Q3: 37–80 | 0.89 (0.70, 1.14) | 0.312 |
Q4: >81 | 0.71 (0.53, 0.92) | 0.010 |
Duration of ECMO therapy, day | 1.00 (1.00, 1.03) | 0.225 |
Prior NOAC use | 0.35 (0.15, 0.73) | 0.007 |
Prior statin use | 0.85 (0.60, 1.25) | 0.212 |
Prior warfarin use | 1.21 (0.85, 1.45) | 0.102 |
LMWH use during hospitalization | 1.06 (0.77, 1.45) | 0.642 |
Charlson comorbidity index, point | 1.15 (1.12, 1.20) | <0.001 |
Hypertension, complicated | 0.74 (0.58, 0.95) | 0.020 |
Hypertension, uncomplicated | 0.73 (0.59, 0.88) | 0.003 |
Myocardial infarction | 1.04 (0.87., 1.27) | 0.693 |
Congestive heart failure | 1.04 (0.87, 1.23) | 0.658 |
Peripheral vascular disease | 0.82 (0.68, 1.00) | 0.053 |
Cerebrovascular disease | 75.11 (58.75, 96.03) | <0.001 |
Dementia | 0.44 (0.30, 0.63) | <0.001 |
Chronic pulmonary disease | 0.83 (0.69, 0.99) | 0.035 |
Rheumatic disease | 1.02 (0.73, 1.43) | 0.915 |
Peptic ulcer disease | 0.84 (0.70, 1.01) | 0.059 |
Mild liver disease | 0.83 (0.69, 0.99) | 0.034 |
Diabetes without chronic complication | 0.81 (0.68, 0.97) | 0.018 |
Diabetes with chronic complication | 0.73 (0.57, 0.93) | 0.009 |
Hemiplegia or paraplegia | 1.16 (0.82, 1.64) | 0.391 |
Renal disease | 0.87 (0.66, 1.16) | 0.343 |
Any malignancy | 0.94 (0.73, 1.20) | 0.594 |
Moderate or severe liver disease | 1.56 (1.13, 2.15) | 0.006 |
Metastatic solid tumor | 0.92 (0.53, 1.60) | 0.771 |
AIDS/HIV | 0.00 (0.00, -) | 0.998 |
Dyslipidemia | 0.87 (0.73, 1.04) | 0.114 |
Main diagnosis at ECMO therapy | ||
Cardiovascular group | 1 | |
Respiratory group | 0.58 (0.42, 0.80) | <0.001 |
Other | 0.57 (0.43, 0.73) | <0.001 |
Variable | Multivariable Model | p-Value |
---|---|---|
OR (95% CI) | ||
Cardiovascular group | ||
Total stroke | ||
Anti-PLT group (vs. control) | 0.65 (0.52, 0.78) | <0.001 |
Ischemic stroke | ||
Anti-PLT group (vs. control) | 0.70 (0.55, 0.90) | 0.006 |
Hemorrhagic stroke | ||
Anti-PLT group (vs. control) | 0.50 (0.35, 0.75) | <0.001 |
Respiratory group | ||
Total stroke | ||
Anti-PLT group (vs. control) | 0.90 (0.41, 2.11) | 0.821 |
Ischemic stroke | ||
Anti-PLT group (vs. control) | 0.40 (0.10, 1.53) | 0.179 |
Hemorrhagic stroke | ||
Anti-PLT group (vs. control) | 1.42 (0.43, 4.18) | 0.745 |
Other group | ||
Total stroke | ||
Anti-PLT group (vs. control) | 0.85 (0.48, 1.70) | 0.705 |
Ischemic stroke | ||
Anti-PLT group (vs. control) | 0.95 (0.49, 2.00) | 0.883 |
Hemorrhagic stroke | ||
Anti-PLT group (vs. control) | 0.80 (0.30, 2.18) | 0.642 |
Variable | Entire Cohort (n = 17,237) | ASD | p-Value | PS-Matched Cohort (n = 7818) | ASD | p-Value | ||
---|---|---|---|---|---|---|---|---|
Anti-PLT n = 3909 | Control n = 13,328 | Anti-PLT n = 3909 | Control n = 3909 | |||||
Age, year | 67.1 (10.9) | 57.2 (15.2) | 0.906 | <0.001 | 67.1 (10.9) | 66.4 (11.8) | 0.061 | 0.009 |
Sex, male | 2705 (69.2) | 8778 (65.9) | 0.072 | <0.001 | 2705 (69.2) | 2670 (68.3) | 0.019 | 0.393 |
Residence at ECMO therapy | 0.604 | 0.945 | ||||||
Capital city (Seoul) | 917 (23.4) | 3081 (23.1) | 917 (23.4) | 928 (23.7) | ||||
Other metropolitan city | 885 (22.6) | 3119 (23.4) | 0.018 | 885 (22.6) | 876 (22.4) | 0.005 | ||
Other area | 2107 (53.9) | 7128 (53.5) | 0.008 | 2107 (53.9) | 2105 (53.9) | 0.001 | ||
Annual income level at ECMO therapy | <0.001 | 0.572 | ||||||
Q1 (Lowest) | 995 (25.5) | 3323 (24.9) | 995 (25.5) | 993 (25.4) | ||||
Q2 | 591 (15.1) | 2551 (19.1) | 0.112 | 591 (15.1) | 631 (16.1) | 0.029 | ||
Q3 | 859 (22.0) | 3095 (23.2) | 0.030 | 859 (22.0) | 865 (22.1) | 0.004 | ||
Q4 (Highest) | 1464 (37.5) | 4359 (32.7) | 0.098 | 1464 (37.5) | 1420 (36.3) | 0.023 | ||
Annual case volume of ECMO therapy | 0.016 | 0.825 | ||||||
Q1: <17 | 1049 (26.8) | 3423 (25.7) | 1049 (26.8) | 1035 (26.5) | ||||
Q2: 17–36 | 1105 (28.3) | 3545 (26.6) | 0.112 | 1105 (28.3) | 1143 (29.2) | 0.022 | ||
Q3: 37–80 | 1035 (26.5) | 3690 (27.7) | 0.030 | 1035 (26.5) | 1022 (26.1) | 0.008 | ||
Q4: >81 | 720 (18.4) | 2670 (20.0) | 0.098 | 720 (18.4) | 709 (18.1) | 0.007 | ||
Duration of ECMO therapy, day | 5.4 (6.6) | 6.5 (9.4) | 0.159 | <0.001 | 5.4 (6.6) | 5.4 (6.6) | 0.021 | 0.140 |
Prior NOAC use | 82 (2.1) | 186 (1.4) | 0.049 | 0.002 | 82 (2.1) | 82 (2.1) | 0.016 | 0.489 |
LMWH use during hospitalization | 361 (9.2) | 1002 (7.5) | 0.059 | <0.001 | 361 (9.2) | 361 (9.2) | 0.004 | 0.845 |
Prior statin use | 945 (24.2) | 2847 (21.4) | 0.092 | <0.001 | 945 (24.2) | 921 (23.6) | 0.008 | 0.354 |
Prior warfarin use | 39 (1.0) | 170 (1.3) | 0.030 | <0.001 | 39 (1.0) | 45 (1.2) | 0.001 | 0.210 |
Charlson comorbidity index | 4.7 (2.9) | 4.0 (2.8) | 0.236 | <0.001 | 4.7 (2.9) | 4.7 (2.9) | 0.018 | 0.421 |
Hypertension, complicated | 985 (25.2) | 1496 (11.2) | 0.321 | <0.001 | 985 (25.2) | 894 (22.9) | 0.012 | 0.016 |
Hypertension, uncomplicated | 3608 (92.3) | 7756 (58.2) | 1.279 | <0.001 | 3608 (92.3) | 3623 (92.7) | 0.002 | 0.521 |
Myocardial infarction | 1772 (45.3) | 4121 (30.9) | 0.290 | <0.001 | 1772 (45.3) | 1732 (44.3) | 0.022 | 0.363 |
Congestive heart failure | 1912 (48.9) | 5100 (38.3) | 0.213 | <0.001 | 1912 (48.9) | 1861 (47.6) | 0.026 | 0.248 |
Peripheral vascular disease | 1255 (32.1) | 2380 (17.9) | 0.305 | <0.001 | 1255 (32.1) | 1212 (31.0) | 0.024 | 0.295 |
Cerebrovascular disease | 1168 (29.9) | 2113 (15.9) | 0.306 | <0.001 | 1168 (29.9) | 1072 (27.4) | 0.054 | 0.016 |
Dementia | 276 (7.1) | 452 (3.4) | 0.142 | <0.001 | 276 (7.1) | 264 (6.8) | 0.012 | 0.593 |
Chronic pulmonary disease | 1631 (41.7) | 5444 (40.8) | 0.018 | 0.327 | 1631 (41.7) | 1717 (43.9) | 0.045 | 0.052 |
Rheumatic disease | 243 (6.2) | 907 (6.8) | 0.024 | 0.195 | 243 (6.2) | 250 (6.4) | 0.007 | 0.745 |
Peptic ulcer disease | 1291 (33.0) | 4035 (30.3) | 0.059 | 0.001 | 1291 (33.0) | 1301 (33.3) | 0.005 | 0.810 |
Mild liver disease | 1412 (36.1) | 4642 (34.8) | 0.027 | 0.136 | 1412 (36.1) | 1429 (36.6) | 0.009 | 0.689 |
Diabetes without chronic complication | 2022 (51.7) | 6183 (46.4) | 0.107 | <0.001 | 2022 (51.7) | 2049 (52.4) | 0.014 | 0.541 |
Diabetes with chronic complication | 924 (23.6) | 1668 (12.5) | 0.262 | <0.001 | 924 (23.6) | 876 (22.4) | 0.029 | 0.197 |
Hemiplegia or paraplegia | 118 (3.0) | 298 (2.2) | 0.046 | 0.005 | 118 (3.0) | 114 (2.9) | 0.006 | 0.790 |
Renal disease | 548 (14.0) | 1211 (9.1) | 0.142 | <0.001 | 548 (14.0) | 541 (13.8) | 0.005 | 0.819 |
Any malignancy | 590 (15.1) | 2493 (18.7) | 0.101 | <0.001 | 590 (15.1) | 579 (14.8) | 0.008 | 0.727 |
Moderate or severe liver disease | 133 (3.4) | 1075 (8.1) | 0.257 | <0.001 | 133 (3.4) | 126 (3.2) | 0.010 | 0.658 |
Metastatic solid tumor | 82 (2.1) | 515 (3.9) | 0.123 | <0.001 | 82 (2.1) | 93 (2.4) | 0.020 | 0.400 |
AIDS/HIV | 2 (0.1) | 26 (0.2) | 0.064 | 0.049 | 2 (0.1) | 1 (0.0) | 0.011 | 0.564 |
Dyslipidemia | 2677 (68.5) | 5678 (42.6) | 0.557 | <0.001 | 2677 (68.5) | 2578 (66.0) | 0.055 | 0.018 |
Year of ECMO therapy | <0.001 | 0.535 | ||||||
2009–2010 | 293 (7.5) | 1275 (9.6) | 293 (7.5) | 328 (8.4) | ||||
2011–2012 | 687 (17.6) | 2049 (15.4) | 0.058 | 687 (17.6) | 651 (16.7) | 0.024 | ||
2013–2014 | 877 (22.4) | 2886 (21.7) | 0.019 | 877 (22.4) | 869 (22.2) | 0.005 | ||
2015–2016 | 917 (23.5) | 3317 (24.9) | 0.034 | 917 (23.5) | 909 (23.3) | 0.005 | ||
2017–2018 | 1135 (29.0) | 3801 (28.5) | 0.011 | 1135 (29.0) | 1152 (29.5) | 0.010 | ||
Main diagnosis at ECMO therapy | <0.001 | 0.402 | ||||||
Cardiovascular group | 3134 (80.2) | 7895 (59.2) | 3134 (80.2) | 3088 (79.0) | ||||
Respiratory group | 304 (7.8) | 1699 (12.7) | 0.186 | 304 (7.8) | 330 (8.4) | 0.025 | ||
Other group | 471 (12.0) | 3734 (28.0) | 0.490 | 471 (12.0) | 491 (12.6) | 0.016 |
Variable | Event (%) | Logistic Regression Analysis | p-Value |
---|---|---|---|
Odds Ratio (95% CI) | |||
Before PS matching | |||
Total stroke | |||
Control | 608/13,328 (4.6) | 1 | |
Anti-PLT | 171/3909 (4.4) | 0.96 (0.81, 1.14) | 0.620 |
Ischemic stroke | |||
Control | 388/13,328 (2.9) | 1 | |
Anti-PLT | 121/3909 (3.1) | 1.07 (0.87, 1.31) | 0.550 |
Hemorrhagic stroke | |||
Control | 245/13,328 (1.8) | 1 | |
Anti-PLT | 51/3909 (1.3) | 0.71 (0.52, 0.96) | 0.025 |
After PS matching | |||
Total stroke | |||
Control | 233/3909 (6.0) | 1 | |
Anti-PLT | 171/3909 (4.4) | 0.75 (0.60, 0.90) | 0.009 |
Ischemic stroke | |||
Control | 154/3909 (3.9) | 1 | |
Anti-PLT | 121/3909 (3.1) | 0.79 (0.60, 0.98) | 0.043 |
Hemorrhagic stroke | |||
Control | 79/3909 (1.9) | 1 | |
Anti-PLT | 51/3909 (1.3) | 0.65 (0.50, 0.94) | 0.020 |
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Oh, T.-K.; Song, I.-A.; Lee, S.-Y.; Choi, H.-R. Prior Antiplatelet Therapy and Stroke Risk in Critically Ill Patients Undergoing Extracorporeal Membrane Oxygenation. Int. J. Environ. Res. Public Health 2021, 18, 8679. https://doi.org/10.3390/ijerph18168679
Oh T-K, Song I-A, Lee S-Y, Choi H-R. Prior Antiplatelet Therapy and Stroke Risk in Critically Ill Patients Undergoing Extracorporeal Membrane Oxygenation. International Journal of Environmental Research and Public Health. 2021; 18(16):8679. https://doi.org/10.3390/ijerph18168679
Chicago/Turabian StyleOh, Tak-Kyu, In-Ae Song, Sol-Yi Lee, and Hey-Ran Choi. 2021. "Prior Antiplatelet Therapy and Stroke Risk in Critically Ill Patients Undergoing Extracorporeal Membrane Oxygenation" International Journal of Environmental Research and Public Health 18, no. 16: 8679. https://doi.org/10.3390/ijerph18168679