Antiplatelet agents for the treatment of adults with COVID-19

Fischer, Anna-Lena; Messer, Sarah; Riera, Rachel; Martimbianco, Ana Luiza Cabrera; Stegemann, Miriam; Estcourt, Lise J; Weibel, Stephanie; Monsef, Ina; Andreas, Marike; Pacheco, Rafael Leite; Skoetz, Nicole

doi:10.1002/14651858.cd015078

Cited by 5 publications

(5 citation statements)

References 64 publications

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“…We found a two-fold higher risk for major bleeding in patients undergoing AP treatment at the time of hospitalization in the univariate analysis [HR 2.65 (95%CI 1.27-5.52)], but we did not confirm this data in the multivariate analysis, although there was the non-significant estimated two-fold higher risk [AHR 1.98 (95% CI 0.92-4.30)] when compared to individuals not exposed to AP at the time of hospital admission. This finding is in accordance with what is reported in the literature, both for critically ill [47] and not critically ill patients with COVID-19 infection [48], and, also, in patients not hospitalized for COVID-19 disease [42,49]. It is known that the AP effect of the more common AP drugs have a time-to-platelet function recovery after drug interruption of about 5-7 days [50], making the summatory effect on bleeding risk of AC therapy and chronic AP therapy at admission nearly inevitable.…”

Section: Discussionsupporting

confidence: 93%

“…We found that length of stay (median days) was significantly longer in patients with a major bleeding event [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] vs. 14 (IQR 8-24), p < 0.0001)] (Table 3). Death was more frequently observed in patients with major bleeding (34.5% vs. 18.0%, p = 0.039).…”

Section: Outcome Of Subjects With a Major Bleeding Eventmentioning

confidence: 92%

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Major Bleeding Events in Hospitalized COVID-19 Patients: A Retrospective Observational Study

Poloni,

Casalini,

Pozza

et al. 2024

Medicina

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Thromboprophylaxis/anticoagulation treatment is often required in hospitalized COVID-19 patients. We aimed to estimate the prevalence of major bleeding events in hospitalized COVID-19 patients. This was a retrospective observational study including all COVID-19 hospitalized patients ≥18 years of age at one reference center in northern Italy. The crude prevalence (between February 2020–2022) of major bleeding events was estimated as the number of major bleeding episodes divided by patients at risk. Uni- and multivariable Cox models were built to assess factors potentially associated with major bleeding events. Twenty-nine (0.98%) out of 2,945 COVID-19 patients experienced a major bleeding event [prevalence of 0.55% (95%CI 0.37–0.79)], of which five were fatal. Patients who experienced a major bleeding event were older [78 years (72–84 IQR) vs. 67 years (55–78 IQR), p-value < 0.001] and more frequently exposed to anti-aggregating therapy (44.8% vs. 20.0%, p-value 0.002) when compared to those who did not. In the multivariable Cox model, age [per 1 year more AHR 1.05 (CI95% 1.02–1.09)] was independently associated with an increased risk of major bleeding events. A strict monitoring of older hospitalized COVID-19 patients is warranted due to the risk of major bleeding events.

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Section: Discussionsupporting

confidence: 93%

Section: Outcome Of Subjects With a Major Bleeding Eventmentioning

confidence: 92%

Major Bleeding Events in Hospitalized COVID-19 Patients: A Retrospective Observational Study

Poloni,

Casalini,

Pozza

et al. 2024

Medicina

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“…Anticoagulation has been shown to be more effective in preventing thromboembolic events in atrial brillation which may also explain the lower number of ischemic strokes and TIA in the non-AP group. AP treatment is a well-known risk factor for major bleeding, especially in long-term observation, in older patients, and without the routine use of proton-pump inhibitors (PPI) [37][38][39]. We did not nd any signi cant differences between the groups in terms of hemorrhagic complications.…”

Section: Ap -Antiplatelet Treatmentmentioning

confidence: 83%

“…It should be emphasized that patients with severe disease at baseline (requiring intensive care support) were not included in the study, which contrasts with our analysis in which we examined the entire spectrum of COVID-19 patients requiring hospitalization. Likely, this group of patients would bene t more from AP treatment as it may reduce the increased in ammatory response that underlies the complications of COVID-19, such as septic processes and acute lung injury [39].…”

Section: Ap -Antiplatelet Treatmentmentioning

confidence: 99%

Antiplatelet therapy prior to COVID-19 infection impacts on patients mortality: A propensity score-matched cohort study.

Sokolski,

Reszka,

Adamik

et al. 2023

Preprint

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Hyperinflammation and coagulopathy with interaction with platelets are the pathomechanisms responsible for the unfavorable outcome of COVID-19. Therefore, the role of antiplatelet therapy (AP) therapy in patients with COVID-19 is uncertain. The aim of this study was to investigate if AP has an impact on the in-hospital course and medium-term outcomes in hospitalized COVID-19 patients. The study population (2170 COVID-19 patients: 60 (19) years old, 50% male) was divided into a group of 274 patients receiving any AP prior to COVID-19 infection (AP group), and after propensity score matching, a group of 274 patients without previous AP (non-AP group). Patients from the AP group were less frequently hospitalized in the intensive care unit (9% vs. 15%, P=0.027), developed less often shock (9% vs. 15%, P=0.033), and required less aggressive forms of therapy. The AP group had more coronary revascularizations (5% vs. 1%, P=0.008) and strokes/TIA (5% vs. 1%, P=0.017). The bleeding rate was comparable (6% vs. 9%, P=0.370). The patients from the AP group had lower 3-month mortality: 31% vs. 39%, P=0.032; HR(95%CI): 0.69(0.51–0.93). The groups did not differ significantly in terms of 6-month mortality. The AP may have a beneficial impact on hospital course and mortality in COVID-19.

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“…Current data do not support the use of antiplatelet agents, including aspirin or P2Y12 inhibitor, ticagrelor for either outpatients or inpatients with COVID-19. Systematic review and meta-analysis of four RCTs, including 17,541 hospitalized patients with moderate to severe COVID-19, revealed that antiplatelets had no effect on 28-day mortality and clinical improvement but probably resulted in a slight reduction in thrombotic events and an increase of major bleeding events ( 130 ). Recent RCTs also do not support using antiplatelets to treat COVID-19 ( 131 ).…”

Section: Antiplatelet Therapymentioning

confidence: 99%

COVID-19: An Update on Epidemiology, Prevention and Treatment, September-2023

Simsek-Yavuz

2023

Infect Dis Clin Microbiol

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After a downward trend for more than 12 months, the incidence of COVID-19 has increased in the last months. Although COVID-19 is not as frequent as in the first years of the pandemic, case numbers are still very high, and it causes a significant number of deaths. COVID-19 is not seen with a predictable frequency, at least two times more deadly than the flu, continues as an epidemic, and has not reached the endemic level yet. Currently, the Omicron strains EG.5 and XBB.1.16 are dominant worldwide. Although BA.2.86 and FLip variants, including FL.1.5.1 are not widespread at the moment, both were shown to be highly immune-evasive and require close monitoring. Prevention of COVID-19 relies on vaccinations, surveillance, proper ventilation of enclosed spaces, isolation of patients, and mask usage. Currently, monovalent COVID-19 vaccines, including XBB.1.5 Omicron SARS-CoV-2, are recommended for both primary and booster vaccinations against COVID-19. Monovalent vaccines, including only original SARS-CoV-2 strain, and bivalent vaccines, including original virus plus BA4/5 variant, are no longer recommended against COVID-19. Booster vaccination with XBB.1.5 containing vaccine should be prioritized for patients at high risk for severe COVID-19. Bacillus Calmette–Guérin (BCG) vaccination does not seem to be effective in preventing COVID-19. At the current phase of the pandemic, nirmatrelvir/ritonavir, remdesivir, molnupiravir, sotrovimab (for patients from XBB.1.5 variant dominant settings), and convalescent plasma can be considered for the treatment of high-risk early-stage outpatients with COVID-19, while hospitalized patients with more severe disease can be treated with dexamethasone, anti cytokines including tocilizumab, sarilumab, baricitinib, and tofacitinib and antithrombotic agents including enoxaparin. Remdesivir oral analogues and ensitrelvir fumarate are promising agents for treating acute COVID-19, which are in phase trials now; however, ivermectin, fluvoxamine, and metformin were shown to be ineffective.

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Antiplatelet agents for the treatment of adults with COVID-19

Cited by 5 publications

References 64 publications

Major Bleeding Events in Hospitalized COVID-19 Patients: A Retrospective Observational Study

Major Bleeding Events in Hospitalized COVID-19 Patients: A Retrospective Observational Study

Antiplatelet therapy prior to COVID-19 infection impacts on patients mortality: A propensity score-matched cohort study.

COVID-19: An Update on Epidemiology, Prevention and Treatment, September-2023

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