Intermediate-dose anticoagulation, aspirin, and in-hospital mortality in COVID-19: a propensity score-matched analysis

Meizlish, Matthew L; Goshua, George; Liu, Yiwen; Fine, Rebecca; Amin, Kejal; Chang, Eric Y.; DeFilippo, Nicholas; Keating, Craig; Liu, Yuxin; Mankbadi, Michael; McManus, Dayna; Wang, Stephen; Price, Christina; Bona, Robert; Chaar, Cassius Iyad Ochoa; Chun, Hyung J.; Pine, Alexander B; Rinder, Henry M.; Siner, Jonathan; Neuberg, Donna; Owusu, Kent A.; Lee, Alfred Ian

doi:10.1101/2021.01.12.21249577

Cited by 47 publications

(71 citation statements)

References 42 publications

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“…Other than anticoagulant therapy, antiplatelet therapy may also be a potential consideration for COVID-19. A propensity score-matched analysis reported a significantly lower incidence of in-hospital death in the aspirin cohort compared with no aspirin [114]. However, antiplatelet therapy will increase the risk of bleeding when combined with anticoagulant therapy.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Viral-Induced Inflammatory Coagulation Disorders: Preparing for Another Epidemic

2021

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A number of viral infectious diseases have emerged or reemerged from wildlife vectors that have generated serious threats to global health. Increased international traveling and commerce increase the risk of transmission of viral or other infectious diseases. In addition, recent climate changes accelerate the potential spread of domestic disease. The Coronavirus disease 2019 (COVID-19) pandemic is an important example of the worldwide spread, and the current epidemic will unlikely be the last. Viral hemorrhagic fevers, such as Dengue and Lassa fevers, may also have the potential to spread worldwide with a significant impact on public health with unpredictable timing. Based on the important lessons learned from COVID-19, it would be prudent to prepare for future pandemics of life-threatening viral diseases. Among the various threats, this review focuses on the coagulopathy of acute viral infections since hypercoagulability has been a major challenge in COVID-19, but represents a different presentation compared to viral hemorrhagic fever. However, both thrombosis and hemorrhage are understood as the result of thromboinflammation due to viral infections, and the role of anticoagulation is important to consider.

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Section: Accepted Manuscriptmentioning

confidence: 99%

Viral-Induced Inflammatory Coagulation Disorders: Preparing for Another Epidemic

2021

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“…Several observational studies reported on the repurposing of established drugs like aspirin [35] and statins [36] to abolish COVID-19 clinical thrombo-embolic endpoints.…”

Section: Page 10 Proteomicsmentioning

confidence: 99%

“…Several observational studies reported on the repurposing of established drugs like aspirin [35] and statins [36] to abolish COVID‐19 clinical thrombo‐embolic endpoints. However, proteomic data are usually not available from these observational studies.…”

Section: Treatment Number Of Datasets (Subjects) Age (±Sd) Male/female Mean Cov50 Before Treatment (± Sd) Mean Cov50 After Treatment (± Smentioning

confidence: 99%

SGLT2‐Inhibition reverts urinary peptide changes associated with severe COVID‐19: An in‐silico proof‐of‐principle of proteomics‐based drug repurposing

et al. 2021

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Severe COVID-19 is reflected by significant changes in urine peptides. Based on this observation, a clinical test predicting COVID-19 severity, CoV50, was developed and registered as in vitro diagnostic in Germany. We have hypothesized that molecular changes displayed by CoV50, likely reflective of endothelial damage, may be reversed by specific drugs. Such an impact by a drug could indicate potential benefits in the context of COVID-19. To test this hypothesis, urinary peptide data from patients without COVID-19 prior to and after drug treatment were collected from the human urinary proteome database. The drugs chosen were selected based on availability of sufficient number of participants in the dataset (n>20) and potential value of drug therapies in the treatment of COVID-19 based on reports in the literature. In these participants without COVID-19, spironolactone did not demonstrate a significant impact on CoV50 scoring. Empagliflozin treatment resulted in a significant change in CoV50 scoring, indicative of a potential therapeutic benefit. The study serves as a proof-of-principle for a drug repurposing approach based on human urinary peptide signatures. The results support the initiation of a randomised control trial testing a potential positive effect of empagliflozin for severe COVID-19, possibly via endothelial protective mechanisms.

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“…Unless formal anticoagulation is indicated, (per guidelines contingent upon D-Dimer levels), we recommend 1 baby aspirin daily (81 mg) for purposes of reducing clot and sludging via platelet inhibition (unless aspirin in the patient is contraindicated). [68][69][70][71][72][73][74][75][76][77]…”

Section: Baby Aspirinmentioning

confidence: 99%

Application of an evidence-based, out-patient treatment strategy for COVID-19: Multidisciplinary medical practice principles to prevent severe disease

Frohman

Villemarette-Pittman

Rodríguez

et al. 2021

Journal of the Neurological Sciences

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The COVID-19 pandemic has devastated individuals, families, and institutions throughout the world. Despite the breakneck speed of vaccine development, the human population remains at risk of further devastation. The decision to not become vaccinated, the protracted rollout of available vaccine, vaccine failure, mutational forms of the SARS virus, which may exhibit mounting resistance to our molecular strike at only one form of the viral family, and the rapid ability of the virus(es) to hitch a ride on our global transportation systems, means that we are will likely continue to confront an invisible, yet devastating foe. The enemy targets one of our human physiology's most important and vulnerable life-preserving body tissue; our brocho-alveolar gas exchange apparatus. Notwithstanding the fear and the fury of this microbe's potential to raise existential questions across the entire spectrum of human endeavor, the application of an early treatment intervention initiative, may represent a crucial tool in our defensive strategy. This strategy is driven by evidence-based medical practice principles, those not likely to become antiquated, given the molecular diversity and mutational evolution of this very clever “world traveler” .

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Intermediate-dose anticoagulation, aspirin, and in-hospital mortality in COVID-19: a propensity score-matched analysis

Cited by 47 publications

References 42 publications

Viral-Induced Inflammatory Coagulation Disorders: Preparing for Another Epidemic

Viral-Induced Inflammatory Coagulation Disorders: Preparing for Another Epidemic

SGLT2‐Inhibition reverts urinary peptide changes associated with severe COVID‐19: An in‐silico proof‐of‐principle of proteomics‐based drug repurposing

Application of an evidence-based, out-patient treatment strategy for COVID-19: Multidisciplinary medical practice principles to prevent severe disease

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