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

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Combined anticoagulant and antiplatelet therapy is associated with an improved outcome in hospitalised patients with COVID-19: a propensity matched cohort study
  1. Kamal Matli1,2,
  2. Nibal Chamoun3,
  3. Aya Fares2,
  4. Victor Zibara4,
  5. Soad Al-Osta4,
  6. Rabih Nasrallah2,
  7. Pascale Salameh5,6,
  8. Jacques Mokhbat2,4 and
  9. Georges Ghanem1,4
  1. 1Cardiology, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
  2. 2Internal Medicine, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
  3. 3Department of Pharmacy Practice, Lebanese American University School of Pharmacy, Byblos, Lebanon
  4. 4Lebanese American University School of Medicine, Byblos, Lebanon
  5. 5Lebanese University Faculty of Pharmacy, Hadath, Lebanon
  6. 6University of Nicosia Medical School, Nicosia, Cyprus
  1. Correspondence to Dr Georges Ghanem; gghanemresearch{at}gmail.com

Abstract

Background COVID-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.

Methods A 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.

Results 242 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.

Conclusion The 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.

  • microvascular angina
  • COVID-19
  • pharmacology
  • clinical

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article and are available on reasonable request from the last author GG.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2021-001785

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    Data availability statement

    Data are available upon reasonable request. All data relevant to the study are included in the article and are available on reasonable request from the last author GG.

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    Footnotes

    • JM and GG are joint senior authors.

    • Twitter @Kamal Matli @KamalMatli

    • AF and VZ contributed equally.

    • SA-O and RN contributed equally.

    • Contributors All coauthors contributed to this work. KM contributed to hypothesis conception, study design, data analysis and interpretation and wrote the final draft of manuscript. NC contributed to study design, data analysis and interpretation and contributed to writing the manuscript. AF contributed to data extraction and contributed to writing the manuscript. VZ contributed to data entry and analysis and contributed to writing the manuscript. SA-O and RN contributed to data extraction and managed the references. PS contributed to data analysis and interpretation as well as critical revisions of the manuscript. JM and GG contributed to critical revisions of the manuscript. All authors read and approved the final version of the manuscript before submission for publication.

    • 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.

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