Prehospital Aspirin Use and ARDS – A Case for Aspirin in the Drinking Water?
Abstract
In this issue of Critical Care Medicine, Chen and colleagues present a cross-sectional analysis demonstrating that prehospital aspirin use is associated with a significant decrease in the incidence of acute respiratory distress syndrome (ARDS) during the first four days of ICU admission, adjusting for the propensity to receive aspirin (1). Preclinical data have suggested a potential role for platelet inhibition in preventing acute lung injury (2-4). Multiple observational studies examining the association between aspirin therapy and the development of ARDS have had inconclusive results (5-7). The largest study to date by Kor et al used propensity matching to balance potential confounding variables between aspirin users and non-users and concluded that prehospital aspirin therapy did not reduce the risk of lung injury (6).
The study by Chen et al has several important strengths. First, the investigators limited this analysis to a more homogenous group of lung injury patients by excluding trauma and surgical patients. Trauma and surgical patients may have unreliable medication histories or indications to discontinue aspirin therapy prior to admission. Second, the VALID cohort has been NIH funded as a prospective cohort study with very detailed phenotyping of lung injury by experts. Therefore, misclassification of their outcome is minimized, and should not be influenced by such factors as heart failure, which could in turn be related to aspirin use. Third, the cohort used for…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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