Chair of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli" - Monaldi and Cotugno Hospital, Naples, Italy.
Division of Cardiology, Eboli Hospital, Salerno, Italy.
Pharmacol Res. 2020 Sep;159:104965. doi: 10.1016/j.phrs.2020.104965. Epub 2020 May 29.
Little is still known about the clinical features associated with the occurrence of acute respiratory distress syndrome (ARDS) in hospitalized patients with Coronavirus disease 2019 (COVID-19). The aim of the present study was to describe the prevalence of pre-admission antithrombotic therapies in patients with COVID-19 and to investigate the potential association between antithrombotic therapy and ARDS, as disease clinical presentation, or in-hospital mortality. We enrolled 192 consecutive patients with laboratory-confirmed COVID-19 admitted to emergency department of five Italian hospitals. The study population was divided in two groups according to the evidence of ARDS at chest computed tomography at admission. Propensity score weighting adjusted regression analysis was performed to assess the risk ARDS at admission, and death during hospitalization, in patients treated or not with antiplatelet and anticoagulant agents. ARDS was reported in 73 cases (38 %), who showed more likely hypertension compared to those without ARDS (57.8 % vs 49.6 %; P = 0.005). Thirty-five patients (18.5 %) died during the hospitalization. Not survived COVID-19 patients showed a statistically significant increased age (77 ± 8.31 vs 65.57 ± 8.31; P = 0.001), hypertension (77.1 % vs 53.5 %; P = 0.018) and coronary artery disease prevalence (28.6 % vs 10.2 %; P = 0.009). Both unadjusted and adjusted regression analyses showed no difference in the risk of ARDS at admission, or death during hospitalization, between patients treated or not with antiplatelets or anticoagulants. Pre-admission antithrombotic therapy, both antiplatelet and anticoagulant, does not seem to show a protective effect in severe forms of COVID-19 with ARDS at presentation and rapidly evolving toward death.
关于与 2019 年冠状病毒病（COVID-19）住院患者发生急性呼吸窘迫综合征（ARDS）相关的临床特征，目前了解甚少。本研究旨在描述 COVID-19 患者入院前抗血栓治疗的流行情况，并探讨抗血栓治疗与 ARDS 作为疾病临床表现或住院死亡率之间的潜在关联。我们纳入了 192 例连续确诊的 COVID-19 患者，这些患者均来自意大利五家医院的急诊科。根据入院时胸部计算机断层扫描（CT）的 ARDS 证据，将研究人群分为两组。采用倾向评分加权调整回归分析评估入院时 ARDS 及住院期间死亡的风险，评估是否接受抗血小板和抗凝药物治疗。73 例（38%）患者出现 ARDS，与无 ARDS 患者相比，这些患者更易发生高血压（57.8%比 49.6%；P=0.005）。35 例（18.5%）患者在住院期间死亡。未存活的 COVID-19 患者年龄显著增大（77±8.31 岁比 65.57±8.31 岁；P=0.001），高血压（77.1%比 53.5%；P=0.018）和冠心病发病率（28.6%比 10.2%；P=0.009）更高。无论是否接受抗血小板或抗凝治疗，未校正和校正回归分析均未显示入院时 ARDS 风险或住院期间死亡风险的差异。入院前抗血栓治疗，无论是抗血小板治疗还是抗凝治疗，似乎对表现为 ARDS 且迅速进展为死亡的严重 COVID-19 患者没有保护作用。
