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Antiplatelet therapy and outcome in COVID-19: the Health Outcome Predictive Evaluation Registry
  1. Francesco Santoro1,
  2. Ivan Javier Nuñez-Gil2,
  3. Enrica Vitale3,
  4. Maria C Viana-Llamas4,
  5. Begoña Reche-Martinez5,
  6. Rodolfo Romero-Pareja6,
  7. Gisela Feltez Guzman7,
  8. Inmaculada Fernandez Rozas8,
  9. Aitor Uribarri9,
  10. Víctor Manuel Becerra-Muñoz10,
  11. Emilio Alfonso-Rodriguez11,
  12. Marcos Garcia-Aguado12,
  13. Jia Huang13,
  14. María Elizabeth Ortega-Armas14,
  15. Juan F Garcia Prieto15,
  16. Eva Maria Corral Rubio16,
  17. Fabrizio Ugo17,
  18. Matteo Bianco18,
  19. Alba Mulet19,
  20. Sergio Raposeiras-Roubin20,
  21. Jorge Luis Jativa Mendez21,
  22. Carolina Espejo Paeres22,
  23. Adrián Rodríguez Albarrán23,
  24. Francisco Marín24,
  25. Federico Guerra25,
  26. Ibrahim Akin26,
  27. Bernardo Cortese27,
  28. Harish Ramakrishna28,
  29. Carlos Macaya2,
  30. Antonio Fernandez-Ortiz29,
  31. Natale Daniele Brunetti30
  1. 1Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
  2. 2Department of Cardiology, San Carlos University Hospital, Madrid, Spain
  3. 3Department of Medical and Surgical Sciences, Universita degli Studi di Foggia, Foggia, Italy
  4. 4Department of Intensive Medicine, Hospital General Universitario de Guadalajara, Guadalajara, Spain
  5. 5Department of Emergency, Hospital Universitario La Paz, Madrid, Spain
  6. 6Department of Emergency, Hospital Universitario de Getafe, Getafe, Spain
  7. 7Department of Cardiology, Hospital Nuestra Señora de América, Madrid, Spain
  8. 8Department of Cardiology, Hospital Universitario Severo Ochoa, Leganes, Spain
  9. 9Department of Cardiology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
  10. 10Department of Cardiology, Hospital Clinico Universitario Virgen de la Victoria, Malaga, Spain
  11. 11Department of Cardiology, Institute of Cardiology and Cardiovascular Surgery, Habana, Cuba
  12. 12Department of Cardiology, Puerta de Hierro University Hospital of Majadahonda, Majadahonda, Spain
  13. 13Department of Cardiology, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China
  14. 14Department of Cardiology, Hospital General del norte de of Guayaquil, Guayaquil, Ecuador
  15. 15Department of Emergency Medicine, Hospital de Manises, Valencia, Spain
  16. 16Department of Anesthesiology, Hospital Universitario Infanta Sofia, Madrid, Spain
  17. 17Department of Cardiology, Sant'Andrea Hospital, Vercelli, Italy
  18. 18Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano and Rivoli infermi Hospital, Rivoli, Italy
  19. 19Department of Lung Disease, Hospital Clinico Valencia, Valencia, Spain
  20. 20Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain
  21. 21Department of Cardiology, Hospital de Especialidades de las Fuerzas Armadas, Quito, Ecuador
  22. 22Department of Cardiology, Hospital Universitario Principe de Asturias, Madrid, Spain
  23. 23Department of Cardiology, Hospital Universitario Juan Ramon Jimenez, Huelva, Spain
  24. 24Department of Cardiology, Hospital Clinico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
  25. 25Cardiology and Arrhythmology Department, Marche Polytechnic University, University Hospital 'Ospedali Riuniti', Ancona, Italy
  26. 26First Department of Medicine, Faculty of Medicine, University of Mannheim, Mannheim, Germany
  27. 27Department of Cardiology, Clinica San Carlo, Milan, Italy
  28. 28Department of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
  29. 29Department of Cardiology, San Carlos, University Hospital, Madrid, Spain
  30. 30Department of Medical and Surgical Sciences, Università degli Studi di Foggia, Foggia, Italy
  1. Correspondence to prof Natale Daniele Brunetti, Department of Medical & Surgical Sciences, Università degli Studi di Foggia, Foggia 71122, Italy; nd.brunetti{at}unifg.it

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.

  • COVID-19
  • pharmacology
  • clinical

Data availability statement

Data are available upon reasonable request.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/heartjnl-2021-319552

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • FS and IJN-G are joint first authors.

    • Twitter @FraSantoroMD, @ibnsky, @Auribarri, @S_Raposeiras, @GuerraCardio, @natalebrunetti

    • FS and IJN-G contributed equally.

    • Contributors FS and IJN-G designed the study. EV, MV, BR-M, RR-P, GFG, IFR, AU, VMB-M, EA-R, MG-A, JH, MEO-A, JFG-P, ECR, FU, MB, AM, SR-R, JJ, CE, ARA, FM, FG, IA, BC, HR, CM and AF-O collected data. FS wrote the paper. NDB performed the statistical analysis. NDB and IJN-G supervised the study. FS, IJN-G and NDB were responsible for the data.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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