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Antiplatelet therapy prior to COVID-19 infection impacts on patients mortality: a propensity score-matched cohort study

Sokolski et al., Scientific Reports, doi:10.1038/s41598-024-55407-9
Feb 2024  
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Retrospective 2,170 hospitalized COVID-19 patients showing lower risk of ICU admission, mechanical ventilation use, and lower 3-month mortality with prior antiplatelet (AP) therapy. AP therapy did not increase bleeding risk. Patients with prior AP therapy had significantly lower inflammatory markers at admission. In the subgroup with indications for AP therapy, AP was associated with lower 3- and 6-month mortality. Ongoing acetylsalicylic acid (ASA) treatment was associated with lower mortality compared to ASA suspension during hospitalization.
Study covers remdesivir and aspirin.
Sokolski et al., 28 Feb 2024, retrospective, Poland, peer-reviewed, 11 authors. Contact:
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Antiplatelet therapy prior to COVID-19 infection impacts on patients mortality: a propensity score-matched cohort study
Mateusz Sokolski, Konrad Reszka, Barbara Adamik, Katarzyna Kilis-Pstrusinska, Weronika Lis, Michał Pomorski, Janusz Sokolowski, Adrian Doroszko, Katarzyna Madziarska, Ewa Anita Jankowska, Marcin Protasiewicz
Scientific Reports, doi:10.1038/s41598-024-55407-9
One of the major pathomechanisms of COVID-19 is the interplay of hyperinflammation and disruptions in coagulation processes, involving thrombocytes. Antiplatelet therapy (AP) by antiinflammatory effect and inhibition of platelet aggregation may affect these pathways. The aim of this study was to investigate if AP has an impact on the in-hospital course and medium-term outcomes in hospitalized COVID-19 patients. The study population (2170 COVID-19 patients: mean ± SD age 60 ± 19 years old, 50% male) was divided into a group of 274 patients receiving any AP prior to COVID-19 infection (AP group), and after propensity score matching, a group of 274 patients without previous AP (non-AP group). Patients from the AP group were less frequently hospitalized in the intensive care unit: 9% vs. 15%, 0.55 (0.33-0.94), developed less often shock: 9% vs. 15%, 0.56 (0.33-0.96), and required less aggressive forms of therapy. The AP group had more coronary revascularizations: 5% vs. 1%, 3.48 (2.19-5.55) and strokes/TIA: 5% vs. 1%, 3.63 (1.18-11.2). The bleeding rate was comparable: 7% vs. 7%, 1.06 (0.54-2.06). The patients from the AP group had lower 3-month mortality: 31% vs. 39%, 0.69 (0.51-0.93) and didn't differ significantly in 6-month mortality: 34% vs. 41%, 0.79 (0.60-1.04). When analyzing the subgroup with a history of myocardial infarction and/or coronary revascularization and/or previous stroke/transient ischemic attack and/or peripheral artery disease, AP had a beneficial effect on both 3-month: 37% vs. 56%, 0.58 (0.40-0.86) and 6-month mortality: 42% vs. 57%, 0.63 (0.44-0.92). Moreover, the favourable effect was highly noticeable in this subgroup where acetylsalicylic acid was continued during hospitalization with reduction of in-hospital: 19% vs. 43%, 0.31 (0.15-0.67), 3-month: 30% vs. 54%, 044 (0.26-0.75) and 6-month mortality: 33% vs. 54%, 0.49 (0.29-0.82) when confronted with the subgroup who had acetylsalicylic acid suspension during hospitalization. The AP may have a beneficial impact on hospital course and mortality in COVID-19 and shouldn't be discontinued, especially in high-risk patients. Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global health crisis 1 . SARS-CoV-2 is a single-stranded RNA virus with a high mutation rate 2,3 . Five SARS-CoV-2 variants (alpha, beta, gamma, delta, and omicron) have been identified by WHO as variants of concern. While approximately 80% of SARS-CoV-2 infections are mild to moderate, the clinical presentation and case fatality rate vary depending on the viral variant and comorbidities 4,5 . Thus, the infection fatality rates vary from 0.3 to 5%. The major causes of death are respiratory failure, sepsis/multi-organ failure, OPEN
Author contributions Conceptualization: M.S., M.P.r; formal analysis: M.S., M.Pr..; investigation: M.S., K.R., B.A., K.K-P, W.L., M.Po., J.S., A.D., K.M., E.A.J., M.Pr.; methodology: M.S., M.Pr.; project administration: A.D., K.M., M.Pr., E.A.J.; supervision: M.S., A.D., K.M., M.Pr., EAJ.; visualization: M.S., K.R; writing-original draft, M.S., K.R.; writingreview and editing, M.S., K.R., K.R., B.A., K. K-P, W.L., M.Po., J.S., A.D., K.M., M.Pr., E.A.J. All authors have contributed substantially to this work and have read and agreed to the published version of the manuscript. Competing interests The authors declare no competing interests.
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Late treatment
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