Antiplatelet Medications Protect Against Aortic Dissection and Rupture in Patients With Abdominal Aortic Aneurysms
Key result
Antiplatelet therapy is linked to ~47% lower risk of dissection in abdominal aortic aneurysms.
- OR 0.53
- 95% CI 0.50-0.57
- P<0.001
- n=245,195,028
Why the study?
Does long-term and current use of anti-platelet drugs reduce the incidence of abdominal aortic aneurysm, dissection, and rupture in hospitalized patients?
Key Points
- To determine whether antiplatelet medications protect against the development of abdominal aortic aneurysm (AAA), as well as aortic dissection and rupture in patients with AAA.
- Analyzed 245,195,028 inpatient hospitalizations from the United States National Inpatient Sample (NIS) between 2009 and 2016 using ICD-9 and ICD-10 codes.
- Identified patients with long-term and current antiplatelet drug use, AAA, abdominal aortic dissection, and abdominal aortic rupture.
- Conducted complex sample multivariate regression adjusting for 26 clinical, demographic, and hospital-level variables to evaluate outcomes.
- Antiplatelet agent use was associated with a significantly lower incidence of AAA (OR = 0.70; 95% CI 0.68–0.72, p < 0.001).
- Among patients with AAA, antiplatelet therapy independently protected against both abdominal aortic dissection (OR = 0.53; 95% CI: 0.50–0.57, p < 0.001) and abdominal aortic rupture (OR = 0.67; 95% CI: 0.54–0.82, p < 0.001).
Study Design
Type
Observational (n=245,195,028)
Multicenter
Yes
Structured PICO
Does long-term and current use of anti-platelet drugs reduce the incidence of abdominal aortic aneurysm, dissection, and rupture in hospitalized patients?
P
Population
245,195,028 inpatient hospitalizations from the US National Inpatient Sample between 2009 and 2016, evaluated for the association between antiplatelet use and AAA outcomes.
E
Exposure
Long-term and current use of anti-platelet drugs
C
Comparator
No documented long-term and current use of anti-platelet drugs
O
Outcome
Incidence of abdominal aortic aneurysm (AAA), abdominal aortic dissection, and AAA rupturehard clinical
Main Result
Odds Ratio: 0.53 (95% CI 0.5–0.57)
p-value: p=<0.001
Long-term use of antiplatelet medications is associated with a significantly lower incidence of abdominal aortic aneurysm, dissection, and rupture in a large national inpatient database.
Limitations
- Source data relies on accurate coding, which is only implied for over-the-counter antiplatelet drugs like aspirin.
- The identity of each antiplatelet class utilized cannot be segregated or verified for the current dataset.
- Potential survival bias, as patients with aortic rupture may not survive to receive medical therapy since antiplatelet therapy following aortic dissection and rupture is contraindicated.
- Relies on accurate coding, which is only implied for over-the-counter drugs like aspirin
- Identity of each antiplatelet class utilized cannot be segregated or verified
- Possibility that patients with aortic rupture never survive to receive medical therapy (survival bias)
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Our investigation suggests that drugs that suppress platelet activity protect against the development and progression of abdominal aortic aneurysms. The findings have important implications for a potential role of antiplatelet therapy in the condition.”
“Current guidelines recommend screening for abdominal aortic aneurysm for at-risk patients followed by surgical or endovascular repair if the infrarenal aorta reaches a certain size. Our findings suggest that antiplatelet drugs may play a protective role during that 'wait and see' period.”
“The potential impact of this project is broad since strong preliminary data suggests circulating platelets communicate directly with the blood vessel wall and affect vessel function. This knowledge, combined with what we've learned about a specific platelet receptor that may be a viable target for preventing blood clots, offers promise that the first medical therapy for asymptomatic AAA may be on the horizon.”
Implication
Antiplatelet use was associated with fewer AAA complications; hypothesis-generating and should not yet change practice.
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Cite This Study
Elbadawi et al. (2020) conducted an observational in Abdominal Aortic Aneurysm (AAA) (n=245,195,028). Antiplatelet medications vs. No antiplatelet medication use was evaluated on Abdominal aortic dissection in patients with AAA (OR 0.53, 95% CI 0.50-0.57, p=<0.001). In patients with abdominal aortic aneurysms, the use of antiplatelet agents was associated with a significantly lower risk of abdominal aortic dissection (OR 0.53) and rupture (OR 0.67).