Lother Sylvain A, Teng Wen, Ayilara Olawale, Houston Brett L, Rush Barret, Murthy Srinivas, Nicolau Jose C, Bond Lindsay, Turgeon Alexis F, Marshall John C, Paul Jonathan, Hochman Judith S, Neal Matthew D, Farkouh Michael E, Nkosi Joel, Houston Donald S, Bradbury Charlotte A, Mendelson Asher A, Goligher Ewan C, Garland Allan, Balshaw Robert, Shaw Souradet Y, Lawler Patrick R, Keynan Yoav, Zarychanski Ryan
Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada.
Res Pract Thromb Haemost. 2025 May 21;9(4):102893. doi: 10.1016/j.rpth.2025.102893. eCollection 2025 May.
Therapeutic-dose heparin improves outcomes in noncritically ill patients hospitalized for COVID-19. The effect of antiplatelet exposure in addition to therapeutic-dose heparin is unknown.
To evaluate the effect of antiplatelet exposure in addition to therapeutic-dose heparin on survival without organ support.
We conducted an observational secondary analysis of a multiplatform randomized controlled trial, analyzing noncritically ill patients hospitalized for COVID-19 who received an antiplatelet agent (acetylsalicylic acid or P2Y12 inhibitor) and therapeutic-dose heparin (combination) compared with therapeutic-dose heparin alone (control). We used a 3-level ordinal primary outcome: (1) survival without organ support, (2) survival with organ support, and (3) mortality by day 21. Propensity scores were estimated using logistic regression. Balanced analytic groups were established using stabilized inverse probability of treatment weighting. A proportional odds model was used to estimate the effect of antiplatelet exposure.
Among 1021 patients, 194 (19.0%) were exposed to an antiplatelet (95.4% acetylsalicylic acid) and therapeutic-dose heparin. All patients were used to calculate the propensity scores and stabilized weights. After applying inverse probability of treatment weighting, the effective sample size was 60 in the combination group and 652 in the control group. Means and prevalences of continuous and dichotomous variables were similar between groups, with no evidence of misclassification. Exposure to an antiplatelet was not associated with improved survival without organ support (76.3% vs 80.5%; odds ratio, 1.07; 95% CI, 0.71-1.64).
In noncritically ill patients hospitalized for COVID-19 receiving therapeutic-dose heparin, exposure to an antiplatelet agent was not associated with improved survival without organ support.
治疗剂量的肝素可改善因 COVID-19 住院的非危重症患者的预后。除治疗剂量的肝素外，抗血小板药物的使用效果尚不清楚。
评估除治疗剂量的肝素外，抗血小板药物的使用对无需器官支持的生存率的影响。
我们对一项多平台随机对照试验进行了观察性二次分析，分析因 COVID-19 住院的非危重症患者，这些患者接受了抗血小板药物（阿司匹林或 P2Y12 抑制剂）和治疗剂量的肝素（联合治疗组），并与单独使用治疗剂量肝素的患者（对照组）进行比较。我们使用了一个三级有序主要结局：（1）无需器官支持的生存，（2）需要器官支持的生存，以及（3）第 21 天的死亡率。使用逻辑回归估计倾向评分。使用稳定的逆概率治疗权重建立平衡分析组。使用比例优势模型估计抗血小板药物使用的效果。
在 1021 例患者中，194 例（19.0%）接受了抗血小板药物（95.4%为阿司匹林）和治疗剂量的肝素。所有患者均用于计算倾向评分和稳定权重。应用逆概率治疗权重后，联合治疗组的有效样本量为 60，对照组为 652。连续变量和二分变量的均值和患病率在两组之间相似，没有错误分类的证据。使用抗血小板药物与无需器官支持的生存率提高无关（76.3%对 80.5%；优势比，1.07；95%CI，0.71-1.64）。
在因 COVID-
