Antiplatelet plus anticoagulant therapy linked to better outcomes in COVID-19

Hospitalized patients with COVID-19 who receive antiplatelet and anticoagulant drugs concurrently may fare better than those given only therapeutic anticoagulation (TAC), according to a study.

The study included 242 patients admitted to a single university hospital for COVID-19 infection. They were grouped into four according to treatment: TAC (n=31), prophylactic anticoagulation plus antiplatelet (PACAP; n=95), TAC plus antiplatelet (TACAP; n=65), and prophylactic anticoagulation (PAC; n=95), which was the reference for comparison.

On admission, 43.4 percent of the entire cohort presented with dyspnoea as a primary symptom. The TACAP group had the lowest oxygen level saturation and the highest average weight. In terms of laboratory tests, D-dimer and C-reactive protein (CRP) levels were the highest in the TAC group, while interleukin-6 levels were the highest in the TACAP group.

Majority (92.1 percent) of the patients were put on steroids during their hospital stay. Meanwhile, 97.5 percent were on vitamin C, 64.9 percent were on vitamin D, and 95.9 percent were given zinc. Median days of oxygen requirement were significantly (p<0.001) different among treatment exposure subgroups.

In multivariable Cox regression models, both TACAP and TAC led to fewer incidences of in-hospital all-cause mortality (adjusted hazard ratio [aHR], 0.113, 95 percent confidence interval [CI], 0.028–0.449 and aHR, 0.126, 95 percent CI, 0.028–0.528, respectively) relative to PAC. The number needed to treat was 11 in both groups.

Moreover, PACAP showed a beneficial effect on the risk of invasive mechanical ventilation vs PAC (aHR, 0.07, 95 percent CI, 0.014–0.351).

There were no differences seen in the occurrence of major or minor bleeds, intensive care unit (ICU) admission or the composite outcome of in-hospital mortality, ICU admission, or the need for mechanical ventilation.