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Antiplatelet therapy and outcome in patients with COVID-19. Results from a multi-center international prospective registry (HOPE-COVID19)

Santoro et al., European Heart Journal, doi:10.1093/eurheartj/ehab724.3002
Oct 2021  
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0 0.5 1 1.5 2+ Mortality 71% Improvement Relative Risk Aspirin for COVID-19  Santoro et al.  LATE TREATMENT Is late treatment with aspirin beneficial for COVID-19? Retrospective 7,824 patients in multiple countries Lower mortality with aspirin (p<0.000001) c19early.org Santoro et al., European Heart J., Oct 2021 Favors aspirin Favors control
Aspirin for COVID-19
24th treatment shown to reduce risk in August 2021
 
*, now known with p = 0.000087 from 73 studies, recognized in 3 countries.
Lower risk for mortality and progression.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,200+ studies for 70+ treatments. c19early.org
Retrospective database analysis of 7,824 patients in the HOPE-COVID19 registry, 730 receiving antiplatelet therapy including aspirin, showing lower mortality with treatment. Authors do not provide results restricted to aspirin.
risk of death, 71.0% lower, RR 0.29, p < 0.001, treatment 730, control 7,094, antiplatelet therapy, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Santoro et al., 14 Oct 2021, retrospective, multiple countries, peer-reviewed, 6 authors.
This PaperAspirinAll
Antiplatelet therapy and outcome in patients with COVID-19. Results from a multi-center international prospective registry (HOPE-COVID19)
F Santoro, E Vitale, I Nunez Gil, F Guerra, I El-Battrawy, N D Brunetti
Background: No standard therapy is currently recommended for . Autopsy studies showed high prevalence of platelet-fibrin rich micro-thrombi in several organs. Aim of the study was to evaluate safety and efficacy of antiplatelet therapy (APT) in COVID-19 hospitalized patients and its impact on survival. Methods: 7824 consecutive patients with COVID-19 were enrolled in a multicenter-international prospective registry (HOPE-COVID19). Clinical data and in-hospital complications were recorded. AP regimen, including aspirin and other antiplatelet drugs, was obtained for each patient. Results: During hospitalization 730 (9.3%) patients received AP drugs with single (93%, n=680) or dual APT (7%, n=50). Patients treated with APT were older (73±12 vs 62±17 years, p<0.01), more frequently male (70% vs 64%, p<0.01) and had higher prevalence of diabetes (39.5% vs 17%, p<0.01).
{ 'indexed': {'date-parts': [[2022, 4, 1]], 'date-time': '2022-04-01T09:23:37Z', 'timestamp': 1648805017036}, 'reference-count': 0, 'publisher': 'Oxford University Press (OUP)', 'issue': 'Supplement_1', 'license': [ { 'start': { 'date-parts': [[2021, 10, 1]], 'date-time': '2021-10-01T00:00:00Z', 'timestamp': 1633046400000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': 'https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model'}], 'content-domain': {'domain': [], 'crossmark-restriction': False}, 'published-print': {'date-parts': [[2021, 10, 12]]}, 'abstract': '<jats:title>Abstract</jats:title>\n' ' <jats:sec>\n' ' <jats:title>Background</jats:title>\n' ' <jats:p>No standard therapy is currently recommended for Corona-virus-19 ' 'disease (COVID-19). Autopsy studies showed high prevalence of platelet-fibrin rich ' 'micro-thrombi in several organs. Aim of the study was to evaluate safety and efficacy of ' 'antiplatelet therapy (APT) in COVID-19 hospitalized patients and its impact on ' 'survival.</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Methods</jats:title>\n' ' <jats:p>7824 consecutive patients with COVID-19 were enrolled in a ' 'multicenter-international prospective registry (HOPE-COVID19). Clinical data and in-hospital ' 'complications were recorded. AP regimen, including aspirin and other antiplatelet drugs, was ' 'obtained for each patient.</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Results</jats:title>\n' ' <jats:p>During hospitalization 730 (9.3%) patients received AP drugs with ' 'single (93%, n=680) or dual APT (7%, n=50). Patients treated with APT were older (73±12 vs ' '62±17 years, p&amp;lt;0.01), more frequently male (70% vs 64%, p&amp;lt;0.01) and had higher ' 'prevalence of diabetes (39.5% vs 17%, p&amp;lt;0.01).</jats:p>\n' ' <jats:p>Patients treated with APT showed no differences in terms of ' 'in-hospital mortality (18% vs 19%, p=0.64, Log Rank p=0.23), need of invasive ventilation ' '(8.7% vs 8.5%, p=0.88) and bleeding (2.1% vs 2.4%, p=0.43); However, after excluding patients ' 'treated only with anticoagulation, APT was associated with lower mortality rates (Log Rank ' 'p&amp;lt;0.01, relative risk 0.79, 95% CI 0.70–0.94) (Figure 1).</jats:p>\n' ' <jats:p>At multivariable analysis including age, gender, diabetes, ' 'hypertension, respiratory failure, pre-hospital therapy with antiplatelet drugs, in-hospital ' 'APT, and anticoagulation therapy, in-hospital APT was associated with a lower mortality risk ' '(relative risk 0.29, 95% CI 0.22–0.38, p&amp;lt;0.001).</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Conclusions</jats:title>\n' ' <jats:p>APT during hospitalization for COVID-19 could be associated with ' 'lower mortality risk without increased risk of bleeding. Randomized trials are needed to ' 'confirm these preliminary data.</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Funding Acknowledgement</jats:title>\n' ' <jats:p>Type of funding sources: None. Figure 1</jats:p>\n' ' </jats:sec>', 'DOI': '10.1093/eurheartj/ehab724.3002', 'type': 'journal-article', 'created': { 'date-parts': [[2021, 10, 20]], 'date-time': '2021-10-20T19:41:36Z', 'timestamp': 1634758896000}, 'source': 'Crossref', 'is-referenced-by-count': 0, 'title': 'Antiplatelet therapy and outcome in patients with COVID-19. Results from a multi-center ' 'international prospective registry (HOPE-COVID19)', 'prefix': '10.1093', 'volume': '42', 'author': [ { 'given': 'F', 'family': 'Santoro', 'sequence': 'first', 'affiliation': [{'name': 'University of Foggia, Department of Cardiology, Foggia, Italy'}]}, { 'given': 'E', 'family': 'Vitale', 'sequence': 'additional', 'affiliation': [{'name': 'University of Foggia, Department of Cardiology, Foggia, Italy'}]}, { 'given': 'I', 'family': 'Nunez Gil', 'sequence': 'additional', 'affiliation': [ { 'name': 'Hospital Clinico San Carlos, Deparment of Cardiology, Madrid, ' 'Spain'}]}, { 'given': 'F', 'family': 'Guerra', 'sequence': 'additional', 'affiliation': [ { 'name': 'University Hospital Riuniti of Ancona, Deparment of Cardiology, ' 'Ancona, Italy'}]}, { 'given': 'I', 'family': 'El-Battrawy', 'sequence': 'additional', 'affiliation': [ { 'name': 'University Medical Centre of Mannheim, Deparment of Cardiology, ' 'Mannheim, Germany'}]}, { 'given': 'N D', 'family': 'Brunetti', 'sequence': 'additional', 'affiliation': [{'name': 'University of Foggia, Department of Cardiology, Foggia, Italy'}]}], 'member': '286', 'published-online': {'date-parts': [[2021, 10, 14]]}, 'container-title': 'European Heart Journal', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://academic.oup.com/eurheartj/article-pdf/42/Supplement_1/ehab724.3002/41050914/ehab724.3002.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'syndication'}, { 'URL': 'https://academic.oup.com/eurheartj/article-pdf/42/Supplement_1/ehab724.3002/41050914/ehab724.3002.pdf', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2022, 1, 4]], 'date-time': '2022-01-04T05:59:07Z', 'timestamp': 1641275947000}, 'score': 1, 'resource': { 'primary': { 'URL': 'https://academic.oup.com/eurheartj/article/doi/10.1093/eurheartj/ehab724.3002/6394238'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2021, 10, 1]]}, 'references-count': 0, 'journal-issue': { 'issue': 'Supplement_1', 'published-online': {'date-parts': [[2021, 10, 14]]}, 'published-print': {'date-parts': [[2021, 10, 12]]}}, 'URL': 'http://dx.doi.org/10.1093/eurheartj/ehab724.3002', 'relation': {}, 'ISSN': ['0195-668X', '1522-9645'], 'subject': [], 'published-other': {'date-parts': [[2021, 10, 1]]}, 'published': {'date-parts': [[2021, 10, 1]]}}
Late treatment
is less effective
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