tetano
Editor, Senior Moderator
J Thromb Haemost
. 2021 Aug 29.
doi: 10.1111/jth.15517. Online ahead of print.
Association of Pre-Hospital Antiplatelet Therapy with Survival in Patients Hospitalized with COVID-19: A Propensity Score-Matched Analysis
Jonathan H Chow[SUP] 1 [/SUP], Ying Yin[SUP] 1 [/SUP], David P Yamane[SUP] 2 [/SUP], Danielle Davison[SUP] 2 [/SUP], Ryan Keneally[SUP] 2 [/SUP], Katrina Hawkins[SUP] 2 [/SUP], Gage Parr[SUP] 2 [/SUP], Mustafa Al-Mashat[SUP] 2 [/SUP], Jeffery S Berger[SUP] 2 [/SUP], Reamer L Bushardt[SUP] 2 [/SUP], Michael A Mazzeffi[SUP] 1 [/SUP], Stuart J Nelson[SUP] 2 [/SUP]
Affiliations
Abstract
Purpose: Coronavirus disease-2019 (COVID-19) is associated with hypercoagulability and increased thrombotic risk. The impact of pre-hospital antiplatelet therapy on in-hospital mortality is uncertain.
Methods: This was an observational cohort study of 34,675 patients ≥50 years old from 90 health systems in the United States. Patients were hospitalized with laboratory confirmed COVID-19 between February 2020 and September 2020. For all patients, the propensity to receive pre-hospital antiplatelet therapy was calculated using demographics and comorbidities. Patients were matched based on propensity scores, and in-hospital mortality was compared between the antiplatelet and non-antiplatelet groups.
Results: The propensity score-matched cohort of 17,347 patients was comprised of 6,781 and 10,566 patients in the antiplatelet and non-antiplatelet therapy groups, respectively. In-hospital mortality was significantly lower in patients receiving pre-hospital antiplatelet therapy (18.9% vs. 21.5%, p<0.001), resulting in a 2.6% absolute reduction in mortality (HR 0.81, 95% CI 0.76-0.87, p<0.005). On average, 39 patients needed to be treated to prevent 1 in-hospital death. In the antiplatelet therapy group, there was a significantly lower rate of pulmonary embolism (2.2% vs. 3.0%, p=0.002) and higher rate of epistaxis (0.9% vs. 0.4%, p<0.001). There was no difference in the rate of other hemorrhagic or thrombotic complications.
Conclusions: In the largest observational study to date of pre-hospital antiplatelet therapy in patients with COVID-19, there was an association with significantly lower in-hospital mortality. Randomized controlled trials in diverse patient populations with high rates of baseline comorbidities are needed to determine the ultimate utility of antiplatelet therapy in COVID-19.
Keywords: Antiplatelet therapy; COVID-19; SARS-CoV-2; aspirin; clopidogrel; dipyridamole; prasugrel; ticagrelor.
. 2021 Aug 29.
doi: 10.1111/jth.15517. Online ahead of print.
Association of Pre-Hospital Antiplatelet Therapy with Survival in Patients Hospitalized with COVID-19: A Propensity Score-Matched Analysis
Jonathan H Chow[SUP] 1 [/SUP], Ying Yin[SUP] 1 [/SUP], David P Yamane[SUP] 2 [/SUP], Danielle Davison[SUP] 2 [/SUP], Ryan Keneally[SUP] 2 [/SUP], Katrina Hawkins[SUP] 2 [/SUP], Gage Parr[SUP] 2 [/SUP], Mustafa Al-Mashat[SUP] 2 [/SUP], Jeffery S Berger[SUP] 2 [/SUP], Reamer L Bushardt[SUP] 2 [/SUP], Michael A Mazzeffi[SUP] 1 [/SUP], Stuart J Nelson[SUP] 2 [/SUP]
Affiliations
- PMID: 34455688
- DOI: 10.1111/jth.15517
Abstract
Purpose: Coronavirus disease-2019 (COVID-19) is associated with hypercoagulability and increased thrombotic risk. The impact of pre-hospital antiplatelet therapy on in-hospital mortality is uncertain.
Methods: This was an observational cohort study of 34,675 patients ≥50 years old from 90 health systems in the United States. Patients were hospitalized with laboratory confirmed COVID-19 between February 2020 and September 2020. For all patients, the propensity to receive pre-hospital antiplatelet therapy was calculated using demographics and comorbidities. Patients were matched based on propensity scores, and in-hospital mortality was compared between the antiplatelet and non-antiplatelet groups.
Results: The propensity score-matched cohort of 17,347 patients was comprised of 6,781 and 10,566 patients in the antiplatelet and non-antiplatelet therapy groups, respectively. In-hospital mortality was significantly lower in patients receiving pre-hospital antiplatelet therapy (18.9% vs. 21.5%, p<0.001), resulting in a 2.6% absolute reduction in mortality (HR 0.81, 95% CI 0.76-0.87, p<0.005). On average, 39 patients needed to be treated to prevent 1 in-hospital death. In the antiplatelet therapy group, there was a significantly lower rate of pulmonary embolism (2.2% vs. 3.0%, p=0.002) and higher rate of epistaxis (0.9% vs. 0.4%, p<0.001). There was no difference in the rate of other hemorrhagic or thrombotic complications.
Conclusions: In the largest observational study to date of pre-hospital antiplatelet therapy in patients with COVID-19, there was an association with significantly lower in-hospital mortality. Randomized controlled trials in diverse patient populations with high rates of baseline comorbidities are needed to determine the ultimate utility of antiplatelet therapy in COVID-19.
Keywords: Antiplatelet therapy; COVID-19; SARS-CoV-2; aspirin; clopidogrel; dipyridamole; prasugrel; ticagrelor.