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Santoro F, Nuñez-Gil IJ, Vitale E, Viana-Llamas MC, Reche-Martinez B, Romero-Pareja R, Feltez Guzman G, Fernandez Rozas I, Uribarri A, Becerra-Muñoz VM, Alfonso-Rodriguez E, Garcia-Aguado M, Huang J, Ortega-Armas ME, Garcia Prieto JF, Corral Rubio EM, Ugo F, Bianco M, Mulet A, Raposeiras-Roubin S, Jativa Mendez JL, Espejo Paeres C, Albarrán AR, Marín F, Guerra F, Akin I, Cortese B, Ramakrishna H, Macaya C, Fernandez-Ortiz A, Brunetti ND. Antiplatelet therapy and outcome in COVID-19: the Health Outcome Predictive Evaluation Registry. Heart 2022; 108:130-136. [PMID: 34611045 PMCID: PMC8494537 DOI: 10.1136/heartjnl-2021-319552] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/30/2021] [Indexed: 12/14/2022] Open
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.
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Affiliation(s)
- Francesco Santoro
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Enrica Vitale
- Department of Medical and Surgical Sciences, Universita degli Studi di Foggia, Foggia, Italy
| | - Maria C Viana-Llamas
- Department of Intensive Medicine, Hospital General Universitario de Guadalajara, Guadalajara, Spain
| | | | | | | | | | - Aitor Uribarri
- Department of Cardiology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | | | | | - Marcos Garcia-Aguado
- Department of Cardiology, Puerta de Hierro University Hospital of Majadahonda, Majadahonda, Spain
| | - Jia Huang
- Department of Cardiology, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
| | | | | | | | - Fabrizio Ugo
- Department of Cardiology, Sant'Andrea Hospital, Vercelli, Italy
| | - Matteo Bianco
- Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano and Rivoli infermi Hospital, Rivoli, Italy
| | - Alba Mulet
- Department of Lung Disease, Hospital Clinico Valencia, Valencia, Spain
| | | | | | | | | | - Francisco Marín
- Department of Cardiology, Hospital Clinico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Federico Guerra
- Cardiology and Arrhythmology Department, Marche Polytechnic University, University Hospital 'Ospedali Riuniti', Ancona, Italy
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University of Mannheim, Mannheim, Germany
| | | | - Harish Ramakrishna
- Department of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Carlos Macaya
- Department of Cardiology, San Carlos University Hospital, Madrid, Spain
| | | | - Natale Daniele Brunetti
- Department of Medical and Surgical Sciences, Università degli Studi di Foggia, Foggia, Italy
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