Abstract
While evidence is accumulating that platelets contribute to tissue destruction in tuberculosis (TB) disease, it is still not known whether antiplatelet agents are beneficial to TB patients. We performed this retrospective cohort study and identified incident TB cases in the Taiwan National Tuberculosis Registry from 2008 to 2014. These cases were further classified into antiplatelet users and non-users according to the use of antiplatelet agents prior to the TB diagnosis, and the cohorts were matched using propensity scores (PSs). The primary outcome was survival after a TB diagnosis. In total, 74,753 incident TB cases were recruited; 9497 (12.7%) were antiplatelet users, and 7764 (10.4%) were aspirin (ASA) users. A 1:1 PS-matched cohort with 8864 antiplatelet agent users and 8864 non-users was created. After PS matching, antiplatelet use remained associated with a longer survival (adjusted hazard ratio (HR): 0.91, 95% confidence interval (CI): 0.88–0.95, p < 0.0001). The risk of major bleeding was not elevated in antiplatelet users compared to non-users (p = 0.604). This study shows that use of antiplatelet agents has been associated with improved survival in TB patients. The immunomodulatory and anti-inflammatory effects of antiplatelet agents in TB disease warrant further investigation. Antiplatelets are promising as an adjunct anti-TB therapy.
Highlights
Tuberculosis (TB) remains an important global infectious disease with an estimated 10 million new cases and 1.6 million deaths in 2017 [1]
In our population-based study, we found that antiplatelet use was associated with better overall survival and lower 12-month mortality in pulmonary TB patients who received anti-TB treatment
ASA, which constitutes the majority of antiplatelet agents, provided a survival advantage for TB patients and may be a candidate for auxiliary anti-TB treatment
Summary
Tuberculosis (TB) remains an important global infectious disease with an estimated 10 million new cases and 1.6 million deaths in 2017 [1]. Active platelets were present at sites of pulmonary TB, and a co-culture with platelets decreased the intracellular killing of Mycobacterium tuberculosis and increased its replication [9]. Another more recent study further provided in vivo experimental evidence that infection-induced platelet activation is a potential target for TB host directed therapy [10]. No epidemiologic studies have examined this question We initiated this population-based study to investigate the clinical impacts of antiplatelet agents on the survival of TB patients. Through the linkage of the Taiwan National Tuberculosis Registry (TNTR) database, the Taiwan National Health Insurance (NHI) database, and national mortality data, we recruited incident TB cases and evaluated whether antiplatelet agents were associated with better outcomes
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