Aspirin and P2Y12 inhibitors in treating COVID-19

Khalaji, Amirmohammad; Behnoush, Amir Hossein; Peiman, Soheil

doi:10.1016/j.ejim.2022.11.027

Cited by 4 publications

(4 citation statements)

References 8 publications

(7 reference statements)

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“…Since the efficacy of antiviral drugs and corticosteroids in treating COVID-19 is not well-proven [ 28 ], studies determined the effectiveness of more available and cheaper medications such as statins [ 29 ], antiplatelets [ 30 ], and anticoagulants [ 31 ] in decreasing post-infection complications. The rationale behind choosing anti-dyslipidemic agents ( e.g., statins) in COVID-19 patients is the role of dyslipidemia and cardiovascular complications in the prognosis of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Adjunctive therapy with lipid-lowering agents in COVID-19: a systematic review and meta-analysis of randomized controlled trials

et al. 2023

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Background Many commonly used drugs were evaluated as repurposed treatment options since the emergence of the COVID-19 pandemic. The benefit of lipid-lowering agents has been controversial in this regard. In this systematic review, we assessed the effect of these medications as adjunctive therapy in COVID-19 by the inclusion of randomized controlled trials (RCTs). Methods We searched four international databases including PubMed, the Web of Science, Scopus, and Embase for RCTs in April 2023. The primary outcome was mortality, while other efficacy indices were considered secondary outcomes. In order to estimate the pooled effect size of the outcomes, considering the odds ratio (OR) or standardized mean difference (SMD) and 95% confidence interval (CI), random-effect meta-analyses was conducted. Results Ten studies involving 2,167 COVID-19 patients using statins, omega-3 fatty acids, fenofibrate, PCSK9 inhibitors, and nicotinamide as intervention compared to control or placebo, were included. No significant difference was found in terms of mortality (OR 0.96, 95% CI 0.58 to 1.59, p-value = 0.86, I2 = 20.4%) or length of hospital stay (SMD -0.10, 95% CI -0.78 to 0.59, p-value = 0.78, I2 = 92.4%) by adding a statin to the standard of care. The trend was similar for fenofibrate and nicotinamide. PCSK9 inhibition, however, led to decreased mortality and an overall better prognosis. Omega-3 supplementation showed contradicting results in two trials, suggesting the need for further evaluation. Conclusion Although some observational studies found improved outcomes in patients using lipid-lowering agents, our study found no benefit in adding statins, fenofibrate, or nicotinamide to COVID-19 treatment. On the other hand, PCSK9 inhibitors can be a good candidate for further assessment. Finally, there are major limitations in the use of omega-3 supplements in treating COVID-19 and more trials are warranted to evaluate this efficacy.

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Section: Discussionmentioning

confidence: 99%

Adjunctive therapy with lipid-lowering agents in COVID-19: a systematic review and meta-analysis of randomized controlled trials

et al. 2023

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“…A recent meta‐analysis of randomized controlled trials found no benefit in adding antiplatelets to COVID‐19 treatment. 306 Strangely, most of the data linking clinical outcome improvement with antiplatelet therapy relate to aspirin. 307 In this respect, experimental data show that targeting platelets via aspirin precludes neutrophil‐mediated microvascular thrombosis and intravascular coagulation in a murine model of bacterial sepsis.…”

Section: Antiplatelet Agents As Potential Therapeutics For Covid‐19mentioning

confidence: 99%

“…A recent meta‐analysis of randomized controlled trials found no benefit in adding antiplatelets to COVID‐19 treatment 306 . Strangely, most of the data linking clinical outcome improvement with antiplatelet therapy relate to aspirin 307 .…”

Section: Antiplatelet Agents As Potential Therapeutics For Covid‐19mentioning

confidence: 99%

Venous thromboembolism in viral diseases: A comprehensive literature review

Zerangian

Erabi

Poudineh

et al. 2023

Health Science Reports

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Venous thromboembolism (VTE) is known to be a common respiratory and/or cardiovascular complication in hospitalized patients with viral infections. Numerous studies have proven human immunodeficiency virus infection to be a prothrombotic condition. An elevated VTE risk has been observed in critically ill H1N1 influenza patients. VTE risk is remarkably higher in patients infected with the Hepatitis C virus in contrast to uninfected subjects. The elevation of D‐dimer levels supported the association between Chikungunya and the Zika virus and the rise of clinical VTE risk. Varicella‐zoster virus is a risk factor for both cellulitis and the consequent invasive bacterial disease which may take part in thrombotic initiation. Eventually, hospitalized patients infected with the coronavirus disease of 2019 (COVID‐19), the cause of the ongoing worldwide pandemic, could mainly suffer from an anomalous risk of coagulation activation with enhanced venous thrombosis events and poor quality clinical course. Although the risk of VTE in nonhospitalized COVID‐19 patients is not known yet, there are a large number of guidelines and studies on thromboprophylaxis administration for COVID‐19 cases. This study aims to take a detailed look at the effect of viral diseases on VTE, the epidemiology of VTE in viral diseases, and the diagnosis and treatment of VTE.

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“…Interestingly, a more recent meta-analysis study did not discover any significant benefit from adding P2Y 12 blockers to mortality and overall better outcomes. It was rather associated with major bleeding [ 151 ].…”

Section: P2y 12 Activation In the Immune System Du...mentioning

confidence: 99%

The Signaling Pathway of the ADP Receptor P2Y12 in the Immune System: Recent Discoveries and New Challenges

Entsie

Kong

Amoafo

et al. 2023

IJMS

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P2Y12 is a G-protein-coupled receptor that is activated upon ADP binding. Considering its well-established role in platelet activation, blocking P2Y12 has been used as a therapeutic strategy for antiplatelet aggregation in cardiovascular disease patients. However, receptor studies have shown that P2Y12 is functionally expressed not only in platelets and the microglia but also in other cells of the immune system, such as in monocytes, dendritic cells, and T lymphocytes. As a result, studies were carried out investigating whether therapies targeting P2Y12 could also ameliorate inflammatory conditions, such as sepsis, rheumatoid arthritis, neuroinflammation, cancer, COVID-19, atherosclerosis, and diabetes-associated inflammation in animal models and human subjects. This review reports what is known about the expression of P2Y12 in the cells of the immune system and the effect of P2Y12 activation and/or inhibition in inflammatory conditions. Lastly, we will discuss the major problems and challenges in studying this receptor and provide insights on how they can be overcome.

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Aspirin and P2Y12 inhibitors in treating COVID-19

Cited by 4 publications

References 8 publications

Adjunctive therapy with lipid-lowering agents in COVID-19: a systematic review and meta-analysis of randomized controlled trials

Adjunctive therapy with lipid-lowering agents in COVID-19: a systematic review and meta-analysis of randomized controlled trials

Venous thromboembolism in viral diseases: A comprehensive literature review

The Signaling Pathway of the ADP Receptor P2Y12 in the Immune System: Recent Discoveries and New Challenges

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