Antiplatelet therapy confers positive outcomes during COVID-19 hospitalization
During hospitalization for COVID-19, patients who received antiplatelet therapy demonstrated lower risk for mortality and shorter mechanical ventilation duration compared with those who did not receive it, researchers reported.
“Clinical deterioration in COVID-19 seems mainly due to a combination of hyperinflammation, endotheliitis and coagulopathy,” Francesco Santoro, MD, postdoctoral researcher in the department of medical and surgical sciences at the University of Foggia, Italy, and colleagues wrote in Heart. “In this context, aspirin may have antiviral, anti-inflammatory and pleiotropic effects on the endothelium.”
Researchers evaluated 7,824 consecutive patients (mean age, 64 years; 58% men) hospitalized with COVID-19. All patients were enrolled in the Health Outcome Predictive Evaluation for COVID-19 registry, a multicenter international prospective registry, and had clinical data and in-hospital complications recorded. Researchers obtained antiplatelet therapy data, including aspirin and other antiplatelet drugs, from each patient.
Among the cohort, 9% of patients had either single antiplatelet therapy or dual antiplatelet therapy; of those, 93% had single antiplatelet therapy. Patients treated with antiplatelet therapy were older (74 years vs. 63 years), were more commonly male (68% vs. 57%) and were more likely to have diabetes (39% vs. 16%; P < .01 for all).
In an unadjusted analysis, there was no difference by antiplatelet strategy in in-hospital mortality (antiplatelet therapy, 18%; no antiplatelet therapy, 19%; P = .64), invasive ventilation requirement (antiplatelet therapy, 8.7%; no antiplatelet therapy, 8.5%; P = .88), thromboembolic events (antiplatelet therapy, 2.9%; no antiplatelet therapy, 2.5%; P = .34) and bleeding (antiplatelet therapy, 2.1%; no antiplatelet therapy, 2.4%; P = .43). However, the antiplatelet group had shorter duration of mechanical ventilation (8 days vs. 11 days; P = .01).
Compared with patients not on antiplatelet therapy or anticoagulation, those who received antiplatelet therapy had lower mortality rates (RR = 0.79; 95% CI, 0.7-0.94; P < .01). In addition, in-hospital antiplatelet therapy was associated with lower risk for mortality after adjustment for age, gender, diabetes, hypertension, renal failure, respiratory failure, HF, cancer history, need for invasive ventilation, prehospital use of antiplatelet agents and in-hospital anticoagulation therapy (RR = 0.39; 95% CI, 0.32-0.48; P < .01). Antiplatelet therapy was also associated with lower mortality risks among patients in the ICU (RR = 0.42; 95% CI, 0.26-0.67; P < .001) and patients with cancer history (RR = 0.66; 95% CI, 0.44-1.01; P = .056).
“The present study showed that antiplatelet therapy could be a potential additional tool for COVID-19 treatments,” the researchers wrote. “Randomized, double-blinded, adequately powered trials evaluating a combination of antiplatelet and anticoagulation therapy are definitely warranted.”