Combined anticoagulant and antiplatelet therapy is associated with an improved outcome in hospitalised patients with COVID-19

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dc.contributor.author Matli, Kamal
dc.contributor.author Chamoun, Nibal
dc.contributor.author Fares, Aya
dc.contributor.author Zibara, Victor
dc.contributor.author Al-Osta, Soad
dc.contributor.author Nasrallah, Rabih
dc.contributor.author Salameh, Pascale
dc.contributor.author Mokhbat, Jacques
dc.contributor.author Ghanem, Georges
dc.date.accessioned 2022-03-11T13:24:00Z
dc.date.available 2022-03-11T13:24:00Z
dc.date.copyright 2021 en_US
dc.date.issued 2022-03-11
dc.identifier.issn 2053-3624 en_US
dc.identifier.uri http://hdl.handle.net/10725/13388
dc.description.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. en_US
dc.language.iso en en_US
dc.title Combined anticoagulant and antiplatelet therapy is associated with an improved outcome in hospitalised patients with COVID-19 en_US
dc.type Article en_US
dc.description.version Published en_US
dc.title.subtitle a propensity matched cohort study en_US
dc.author.school SOP en_US
dc.author.school SOM
dc.author.idnumber 200201071 en_US
dc.author.idnumber 200902719 en_US
dc.author.idnumber 201000163 en_US
dc.author.department Pharmacy Practice en_US
dc.relation.journal Open Heart en_US
dc.journal.volume 8 en_US
dc.journal.issue 2 en_US
dc.article.pages e001785 en_US
dc.identifier.doi http://dx.doi.org/10.1136/openhrt-2021-001785 en_US
dc.identifier.ctation Matli, K., Chamoun, N., Fares, A., Zibara, V., Al-Osta, S., Nasrallah, R., ... & Ghanem, G. (2021). Combined anticoagulant and antiplatelet therapy is associated with an improved outcome in hospitalised patients with COVID-19: a propensity matched cohort study. Open heart, 8(2), e001785. en_US
dc.author.email nibal.chamoun@lau.edu.lb en_US
dc.author.email jacques.mokhbat@lau.edu.lb en_US
dc.author.email george.ghanem@lau.edu.lb en_US
dc.identifier.tou http://libraries.lau.edu.lb/research/laur/terms-of-use/articles.php en_US
dc.identifier.url https://openheart.bmj.com/content/8/2/e001785.abstract en_US
dc.orcid.id https://orcid.org/0000-0002-0987-296X en_US
dc.orcid.id https://orcid.org/ 0000-0002-0850-0689 en_US
dc.author.affiliation Lebanese American University en_US

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