Association of prehospital antiplatelet therapy with survival in patients hospitalized with COVID‐19: A propensity score‐matched analysis

Abstract

Purpose: Coronavirus disease 2019 (COVID-19) is associated with hypercoagulability and increased thrombotic risk. The impact of prehospital antiplatelet therapy on inhospital 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 prehospital 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 nonantiplatelet groups. Results:The propensity score-matched cohort of 17 347 patients comprised of 6781 and 10 566 patients in the antiplatelet and non-antiplatelet therapy groups, respectively. In-hospital mortality was significantly lower in patients receiving prehospital antiplatelet therapy (18.9% vs. 21.5%, p < .001), resulting in a 2.6% absolute reduction in mortality (HR: 0.81, 95% CI: 0.76-0.87, p < .005). On average, 39 patients needed to be treated to prevent one in-hospital death. In the antiplatelet therapy group, there was a significantly lower rate of pulmonary embolism (2.2% vs. 3.0%, p = .002) and higher rate of epistaxis (0.9% vs. 0.4%, p < .001). There was no difference in the rate of other hemorrhagic or thrombotic complications. Conclusions:In the largest observational study to date of prehospital 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 | 2815 CHOW et al.

Clinical update on COVID-19 for the emergency and critical care clinician: Medical management

“…Investigations of antiplatelet therapies outside of aspirin alone do not consistently demonstrate improved patient outcomes and were nevertheless largely dominated by aspirin therapy. A large study of nearly 35,000 patients ≥50 years old demonstrated improved benefits for those taking antiplatelet therapy prehospital to those who did not for in-hospital mortality (18.9% vs. 21.5%, p < 0.001) and a 2.6% absolute reduction in mortality (HR 0.81, 95% CI 0.76–0.87, p < 0.005) [ 97 ]. However, most patients were taking aspirin (83.9%), with less on clopidogrel (8.2%), dual antiplatelet therapy (7.4%), or ticagrelor or prasugrel, and the authors did not break down differences between therapies.…”

Anticoagulation as a therapeutic strategy for hospitalised patients with COVID-19

“…Studies evaluating the role of the direct oral anticoagulants have also not shown any evidence of a survival benefit to date or of a disease-modifying effect [ 31 ]. Initial observational data suggested that anti-platelet therapy might be beneficial in COVID-19 although no survival advantage or reduction in disease severity was detected in a recent randomised controlled trial, although the outcomes from other additional studies are also awaited [ 32 , 33 ].…”

Longitudinal multiparametric characterization of platelet dysfunction in COVID-19: Effects of disease severity, anticoagulation therapy and inflammatory status

“…Indeed, clinical studies of anti-platelet therapy in COVID-19 demonstrated that aspirin is the only anti-platelet drug that can significantly affect patient's condition [14]. On the other hand, other studies demonstrated that pre-hospitalization antiplatelet therapy can significantly decrease the mortality from COVID-19 [15]. Platelet dysfunction in COVID-19 has been shown several times and most of the authors agree that platelets are pathologically activated [16][17][18][19].…”