Antiplatelet therapy and outcome in COVID-19: the Health Outcome Predictive Evaluation Registry
Francesco Santoro, Iván J. Núñez‐Gil, Enrica Vitale, María C. Viana‐Llamas, Begoña Reche-Martínez, Rodolfo Romero-Pareja, Gisela Feltez Guzman, Inmaculada Fernández Rozas, Aitor Uribarri, Víctor Manuel Becerra‐Muñoz, Emilio Alfonso‐Rodríguez, Marcos García-Aguado, Jia Huang, María Elizabeth Ortega-Armas, Juan Fortunato García Prieto, Eva María Rubio, Fabrizio Ugo, Matteo Bianco, Alba Mulet, Sergio Raposeiras‐Roubín, Jorge Luis Jativa Mendez, Carolina Espejo Paeres, Adrián Rodríguez Albarrán, Francisco Marı́n, Federico Guerra, İbrahim Akın, Bernardo Cortese, Harish Ramakrishna, Carlos Macaya, Antonio Fernández‐Ortíz, Natale Daniele Brunetti
Abstract
BACKGROUND: Standard therapy for COVID-19 is continuously evolving. Autopsy studies showed high prevalence of platelet-fibrin-rich microthrombi in several organs. The aim of the study was therefore to evaluate the safety and efficacy of antiplatelet therapy (APT) in hospitalised patients with COVID-19 and its impact on survival. METHODS: 7824 consecutive patients with COVID-19 were enrolled in a multicentre international prospective registry (Health Outcome Predictive Evaluation-COVID-19 Registry). Clinical data and in-hospital complications were recorded. Data on APT, including aspirin and other antiplatelet drugs, were obtained for each patient. RESULTS: During hospitalisation, 730 (9%) patients received single APT (93%, n=680) or dual APT (7%, n=50). Patients treated with APT were older (74±12 years vs 63±17 years, p<0.01), more frequently male (68% vs 57%, p<0.01) and had higher prevalence of diabetes (39% vs 16%, p<0.01). Patients treated with APT showed no differences in terms of in-hospital mortality (18% vs 19%, p=0.64), need for invasive ventilation (8.7% vs 8.5%, p=0.88), embolic events (2.9% vs 2.5% p=0.34) and bleeding (2.1% vs 2.4%, p=0.43), but had shorter duration of mechanical ventilation (8±5 days vs 11±7 days, p=0.01); however, when comparing patients with APT versus no APT and no anticoagulation therapy, APT was associated with lower mortality rates (log-rank p<0.01, relative risk 0.79, 95% CI 0.70 to 0.94). On multivariable analysis, in-hospital APT was associated with lower mortality risk (relative risk 0.39, 95% CI 0.32 to 0.48, p<0.01). CONCLUSIONS: APT during hospitalisation for COVID-19 could be associated with lower mortality risk and shorter duration of mechanical ventilation, without increased risk of bleeding. TRIAL REGISTRATION NUMBER: NCT04334291.