Combined anticoagulant and antiplatelet therapy is associated with an improved outcome in hospitalised patients with COVID-19: a propensity matched cohort study

Abstract

BackgroundCOVID-19 is a respiratory disease that results in a prothrombotic state manifesting as thrombotic, microthrombotic and thromboembolic events. As a result, several antithrombotic modalities have been implicated in the treatment of this disease. This study aimed to identify if therapeutic anticoagulation (TAC) or concurrent use of antiplatelet and anticoagulants was associated with an improved outcome in this patient population.MethodsA retrospective observational cohort study of adult patients admitted to a single university hospital for COVID-19 infection was performed. The primary outcome was a composite of in-hospital mortality, intensive care unit (ICU) admission or the need for mechanical ventilation. The secondary outcomes were each of the components of the primary outcome, in-hospital mortality, ICU admission, or the need for mechanical ventilation.Results242 patients were included in the study and divided into four subgroups: Therapeutic anticoagulation (TAC), prophylactic anticoagulation+antiplatelet (PACAP), TAC+antiplatelet (TACAP) and prophylactic anticoagulation (PAC) which was the reference for comparison. Multivariable Cox regression analysis and propensity matching were done and showed when compared with PAC, TACAP and TAC were associated with less in-hospital all-cause mortality with an adjusted HR (aHR) of 0.113 (95% CI 0.028 to 0.449) and 0.126 (95% CI 0.028 to 0.528), respectively. The number needed to treat in both subgroups was 11. Furthermore, PACAP was associated with a reduced risk of invasive mechanical ventilation with an aHR of 0.07 (95% CI 0.014 to 0.351). However, the was no statistically significant difference in the occurrence of major or minor bleeds, ICU admission or the composite outcome of in-hospital mortality, ICU admission or the need for mechanical ventilation.ConclusionThe use of combined anticoagulant and antiplatelet agents or TAC alone in hospitalised patients with COVID-19 was associated with a better outcome in comparison to PAC alone without an increase in the risk of major and minor bleeds. Sufficiently powered randomised controlled trials are needed to further evaluate the safety and efficacy of combining antiplatelet and anticoagulants agents or using TAC in the management of patients with COVID-19 infection.

High versus Standard Intensity of Thromboprophylaxis in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

“…Among the 8318 articles initially retrieved through our literature search, 21 fulfilled the inclusion criteria and were included in our analysis [ 11 , 12 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. The PRISMA 2020 flow diagram for systematic reviews and meta-analyses study selection is presented in Supplementary File, Figure S1 .…”

“…The PRISMA 2020 flow diagram for systematic reviews and meta-analyses study selection is presented in Supplementary File, Figure S1 . A total of 7 studies reported data for intermediate versus prophylactic dose [ 11 , 27 , 28 , 29 , 30 , 34 , 35 ], while 17 studies reported data for therapeutic versus prophylactic dose of thromboprophylaxis [ 12 , 23 , 24 , 25 , 26 , 29 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. Three studies contributed data for both intermediate versus prophylactic and therapeutic versus prophylactic dose analyses [ 29 , 34 , 35 ].…”

“…There were 2 randomized [ 12 , 33 ] and 15 observational studies [ 23 , 24 , 25 , 26 , 29 , 31 , 32 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ] ( n = 7776, weighted age 64 years, males 54%, ICU 21%) that reported the RR for death in patients with COVID-19 administered therapeutic versus prophylactic dose of thromboprophylaxis. Meta-analysis of these 17 studies (use of adjusted estimates for non-randomized) revealed a pooled adjusted RR for death at 0.73 (95% CI 0.47, 1.14; I 2 87%) ( Figure 2 ).…”

“…Regarding the secondary outcomes, meta-analysis of 6 studies [ 12 , 29 , 31 , 33 , 34 , 35 ] revealed a pooled unadjusted RR for VTE at 1.13 (95% CI 0.52, 2.48; I 2 58%) and meta-analysis of 9 studies [ 24 , 25 , 29 , 31 , 33 , 34 , 35 , 37 , 38 ] revealed a pooled unadjusted RR for major bleeding events at 3.32 (95% CI 2.51, 4.40; I 2 0%) for therapeutic versus prophylactic dose of thromboprophylaxis.…”

The Role of Herbal and Nutritional Treatments in the Fight against COVID-19 and Other Respiratory Tract Infections

“…COVID-19 has symptoms similar to those of contracting a mild flu (fever, cough, and malaise), although asymptomatic cases and other atypical symptoms have been reported as well [3,4]. In severe cases, symptoms can rapidly develop and lead to respiratory failure and even multi-organ failure, necessitating admission to the intensive care unit (ICU) and initiating mechanical ventilation [5,6]. In 2020, the number of deaths reported to WHO as a result of COVID-19 was estimated to have exceeded 3.3 million deaths.…”