Associations of antithrombotic agent use with clinical outcomes in critically ill patients with troponin I elevation in the absence of acute coronary syndrome

PLoS One. 2020 May 21;15(5):e0233178. doi: 10.1371/journal.pone.0233178. eCollection 2020.

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.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / blood
  • Acute Coronary Syndrome / drug therapy
  • Acute Coronary Syndrome / mortality
  • Aged
  • Aged, 80 and over
  • Critical Illness
  • Disease-Free Survival
  • Female
  • Fibrinolytic Agents / administration & dosage*
  • Hospital Mortality*
  • Humans
  • Intensive Care Units*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Survival Rate
  • Troponin I / blood*
  • Warfarin / administration & dosage*

Substances

  • Fibrinolytic Agents
  • Troponin I
  • Warfarin

Associated data

  • figshare/10.6084/m9.figshare.12154896

Grants and funding

This study was supported, in part, by research grants from the Ministry of Science and Technology of Taiwan (MOST 106-2314-B-350-001-MY3); the Novel Bioengineering and Technological Approaches to Solve Two Major Health Problems in Taiwan program, sponsored by the Taiwan Ministry of Science and Technology Academic Excellence Program (MOST 108-2633-B-009-001); the Ministry of Health and Welfare (MOHW106-TDU-B-211-113001); and Taipei Veterans General Hospital (V105C-207, V106C-045, V108C-195). These funding agencies had no influence on the study design, data collection or analysis, decision to publish, or preparation of the manuscript.