Key result
Early ICU aspirin is linked to ~69% lower 28-day mortality in critically ill cerebral embolism.
Why the study?
To evaluate the association between aspirin administration during the first 24 hours of ICU admission and 28-day all-cause mortality in critically ill adults with cerebral embolism, and explore early cumulative dose associations.
Does aspirin exposure within the first 24 hours of ICU admission reduce 28-day all-cause mortality in critically ill adults with cerebral embolism?
Cohort (n=568)
No
Does aspirin exposure within the first 24 hours of ICU admission reduce 28-day all-cause mortality in critically ill adults with cerebral embolism?
Hazard Ratio: 0.31 (95% CI 0.13–0.73)
p-value: p=0.008
Early aspirin exposure in critically ill patients with cerebral embolism is associated with improved 28-day survival, though residual confounding limits causal conclusions.
Should not yet change practice in cerebral embolism ICU patients; leaves open a mortality benefit requiring prospective confirmation.
Objective To evaluate the association between aspirin administration during the first 24 hours of intensive care unit (ICU) admission and 28-day all-cause mortality among critically ill adults with cerebral embolism and to explore associations with early cumulative dose. Methods This retrospective cohort study used MIMIC-IV version 3.1 and included each patient’s first eligible adult ICU admission . Aspirin exposure was defined as at least one documented administration within 24 hours. After 1:1 propensity-score matching, 125 matched pairs were obtained . Associations were examined using Kaplan–Meier methods and Cox proportional hazards models, with exploratory dose, subgroup, and sensitivity analyses. Given only 45 deaths, a parsimonious Cox model was prioritized over the approximately 40-variable saturated model. Results The cohort included 568 patients (430 aspirin-exposed and 138 unexposed), with 45 deaths by day 28. Aspirin exposure was associated with lower 28-day mortality before matching (HR 0.32, 95% CI 0.18-0.58; P<0.001) and after matching (HR 0.31, 95% CI 0.13-0.73; P=0.008). Matching improved balance, but residual imbalance remained; the largest absolute post-match standardized mean difference in Table 1 was 0.177. The parsimonious adjusted model produced a similar estimate (HR 0.31, 95% CI 0.17-0.57; P<0.001). Dose analyses were exploratory and hypothesis-generating ; sparse dose-specific events, nonrandom treatment selection, and time-related exposure classification prevented identification of an optimal dose. Laboratory abnormalities were examined only as exploratory surrogates; clinical bleeding was not ascertained. Conclusions In this single-center retrospective cohort, aspirin exposure during the first 24 hours of ICU admission was associated with lower 28-day mortality. Residual confounding by unmeasured neurologic stroke severity (because NIHSS was unavailable ), treatment eligibility, and goals of care, together with the absence of adjudicated bleeding outcomes, precludes causal , safety, or dose-prescriptive conclusions . Multicenter prospective studies and adequately powered randomized controlled trials are required before definitive clinical recommendations can be made .
No takes yet. Share an insight, caveat, or question.
Zhu et al. (2026) conducted a cohort in Critically ill adults with cerebral embolism (n=568). Aspirin exposure within first 24 hours of ICU admission vs. No aspirin exposure within first 24 hours was evaluated on 28-day all-cause mortality (HR 0.31, 95% CI 0.13-0.73, p=0.008). Aspirin exposure during the first 24 hours of ICU admission was associated with lower 28-day mortality (HR 0.31) in critically ill adults with cerebral embolism.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: