Discussion
acute infection, cardiovascular disease, infection, chronic cardiovascular disease, platelet aggregation
VIRAL RESPIRATORY TRACT INFECTION, ACUTE INFECTION, CARDIOVASCULAR DISEASE, INFECTION, EVENTS
The salient findings of this trial are as follows: 1) Platelet aggregation is increased during severe infection, and 2) aspirin is effective in inhibiting platelet aggregation and activation as measured by PFA-CT and serum TxB2, although no decrease in plasma TxB2 was observed.The finding of increased platelet aggregation is in line with the results of several other studies, for example seen in patients with COVID-19 and other types of viral respiratory tract infection [Our second finding is that aspirin is effective in inhibiting platelet aggregation and activation based on the observed prolongation of PFA-CT and decrease in sTxB2. This is consistent with studies in healthy subjects or patients with chronic cardiovascular disease [Despite the maintained pTxB2 levels, the reduced level of platelet aggregation and activatability after aspirin intake during acute infection could be of clinical relevance in terms of cardiovascular disease prevention. Similar promising results have been observed in other clinical studies on aspirin therapy during infection. For example chronic aspirin use is associated with a lower occurrence of cardiovascular events and a lower mortality rate in patients hospitalised for infection [Strengths of this trial include the use of three different approaches to measure platelet aggregation and activation, the strict exclusion criteria regarding medication use and the standardisation of blood sampling and laboratory procedures. An important limitation is the early termination of the study, resulting in a small sample size and the inability to compare the two aspirin dosage regimens. However, the observation of changes in platelet aggregation despite the small sample size strengthens our hypothesis. Future research is needed to establish the effects of aspirin administration on clinical endpoints. Therefore, we designed the AS-CAP trial. This is a multicentre, randomised controlled trial in which clinical endpoints will be assessed in patients hospitalised with a severe infection.In conclusion, this multicentre, open-label, randomised controlled trial in patients without a history of cardiovascular disease provides new insights into platelet activation and inhibition during infection. Our study suggests that platelet aggregation is increased in patients with a severe infection, and that aspirin inhibits this process. However, no inhibition of plasma TxB2 was achieved, which means that platelet cyclo-oxygenase residual activity might remain present despite aspirin use. Altogether, we can conclude that aspirin is a promising drug in the prevention of hyperaggregation due to acute infection.