Pre-hospital antiplatelet medication use on COVID-19 disease severity
MD Darren Pan, MD Ada Ip, MS Serena Zhan, MD, MPH Isaac Wasserman, BS e , Daniel J Snyder, BA Alexandra Z Agathis, BA e , Jeong Nikhil Shamapant, Jeong Yun Yang, BS Akila Pai, PhD Madhu Mazumdar, MD Hooman Poor
Heart & Lung, doi:10.1016/j.hrtlng.2021.04.010
Measurements: We captured baseline demographic, pre-hospitalization antiplatelet medication use, and clinical encounter data for all patients who met inclusion criteria. The primary endpoint was peak score on a 6point modified ordinal scale (MOS), which is based on World Health Organization blueprint R&S groups, used to grade severity of illness through clinical outcomes of interest. Scores indicate the following: 1 À COVID-19 infection not requiring hospitalization, 2 À requiring hospitalization but not supplemental oxygen, 3 À hospitalization requiring supplemental oxygen, 4 À hospitalization requiring high-flow nasal cannula (HFNC) or non-invasive positive pressure ventilation (NIPPV), 5 À hospitalization requiring intubation or extracorporeal membrane oxygenation (ECMO), 6 À death. Multivariable adjusted partial proportional odds model (PPOM) was performed to examine the association between pre-hospitalization antiplatelet medication use and likelihood of each MOS score. Main Results: Of 762 people admitted with COVID-19, 239 (31.4%) used antiplatelet medications pre-hospitalization while 523 (68.6%) did not. Antiplatelet users were older and had more co-morbidities at baseline. Before adjusting for covariates, patients who used antiplatelet medications pre-hospitalization were more likely than non-users to have peak MOS score 6 (death, OR 1.75, 95% CI 1.21À2.52), peak MOS score 5 (intubation/ECMO or death, OR 1.4, 95% CI 1.00À1.98) and peak MOS score 4 (HFNC, NIPPV, intubation/ECMO or death, OR 1.40, 95% CI 1.01À1.94). On multivariable adjusted PPOM analysis controlling for 13 covariates, there were no longer any significant differences in peak MOS scores between users and non-users. Conclusions: After adjusting for covariates, pre-hospital antiplatelet use was not associated with COVID-19 severity in hospitalized patients.
Author Contributions Darren Pan and Ada Ip performed chart review and wrote the manuscript. Serena Zhan performed statistical analysis and contributed to writing and editing. Isaac Wasserman, Daniel J. Snyder, Alexandra Z. Agathis, Nikhil Shamapant, Jeong Yun Yang, and Akila Pai performed chart review and contributed to editing. Madhu Mazumdar contributed to editing and provided critical feedback which helped to shape the manuscript. Hooman Poor edited, provided guidance regarding overall direction, and contributed to writing the manuscript.
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