Apr 20, 2020
Associations of antithrombotic agent use with clinical outcomes in critically ill patients with troponin I elevation in the absence of acute coronary syndrome
- Chuan-Tsai Tsai1,
- Ya-Wen Lu1,
- Ruey-Hsing Chou1,
- Yi-Lin Tsai1,
- Ming-Ren Kuo1,
- Jiun-Yu Guo1,
- Chi-Ting Lu1,
- Chin-Sung Kuo1,
- Po-Hsun Huang1
- 1National Yang Ming Medical College
Protocol Citation: Chuan-Tsai Tsai, Ya-Wen Lu, Ruey-Hsing Chou, Yi-Lin Tsai, Ming-Ren Kuo, Jiun-Yu Guo, Chi-Ting Lu, Chin-Sung Kuo, Po-Hsun Huang 2020. Associations of antithrombotic agent use with clinical outcomes in critically ill patients with troponin I elevation in the absence of acute coronary syndrome. protocols.io https://dx.doi.org/10.17504/protocols.io.bfbdjii6
License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: Working
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Created: April 20, 2020
Last Modified: April 20, 2020
Protocol Integer ID: 35909
Abstract
Abstract
Introduction: To evaluate efficacy of antithrombotic agents in critically ill patients with elevated troponin I level during intensive care unit (ICU) admission.
Methods and results: It was a retrospective observational study which was conducted in a tertiary teaching hospital in Taipei, Taiwan. All patients hospitalized in ICU for >3 days and with available serum troponin I data from December 2015 to July 2017 were included. Patients with definite diagnosis of acute myocardial infarction (AMI) were excluded. We divided patients with troponin I elevation into three groups; no prescription, chronic prescription and new prescription of antithrombotic agents during ICU admission. We defined new prescription when patients were on antithrombotic agents, including antiplatelet agents, direct oral anticoagulants, and warfarin after troponin I was found to be elevated at ICU admission and chronic prescription, if antithrombotic agents were on medication list more than 30 days before ICU admission. Primary outcomes were 30-day and one-year all-cause mortality. Of 597 subjects who met inclusion criteria, 407 (68%) patients had elevated troponin I (>0.1 ng/mL) on ICU admission. These patients had increased 30-day [hazard ratio (HR), 1.679; 95% confidence interval (CI), 1.132–2.491; p = 0.009] and one-year (HR, 1.568; 95% CI, 1.180–2.083; p = 0.002) all-cause mortality compared with those without elevated troponin I. In patients with elevated troponin I, there was no significant difference of 30-day all-cause mortality among three groups (p = 0.051) whereas patients on chronic prescription showed significant survival benefit in one-year all-cause mortality when compared to those without or with new prescription (p= 0.008).
Conclusions: In critically ill patients, elevated troponin I in the absence of AMI was associated with poor prognosis. Newly prescribed antithrombotic agents in ICU didn’t reveal the difference in short and long-term prognosis while chronic antithrombotic agent use was associated with better one-year survival rate, suggesting that these drugs play a protective role in this high-risk population.
Keywords: critically ill patient, troponin I elevation, antithrombotic agent, intensive care unit