Effect of Antiplatelet Therapy on Survival and Organ Support-Free Days in Critically Ill Patients With COVID-19: A...

Area of Science:

• Critical care medicine
• Infectious diseases
• Pharmacology

Background:

• The effectiveness of antiplatelet therapy in critically ill COVID-19 patients remains uncertain.
• This study addresses the need for evidence regarding antiplatelet agents in this patient population.

Purpose of the Study:

• To investigate whether antiplatelet therapy improves clinical outcomes in critically ill adults diagnosed with COVID-19.
• To evaluate the impact of aspirin and P2Y12 inhibitors on organ support-free days and survival.

Main Methods:

• An adaptive platform trial (REMAP-CAP) randomized 1557 critically ill COVID-19 patients to aspirin, a P2Y12 inhibitor, or no antiplatelet therapy.
• The primary outcome was organ support-free days within 21 days, with secondary outcomes including survival to discharge and major bleeding.
• Bayesian cumulative logistic models were used for primary analysis, with predefined criteria for efficacy, futility, and equivalence.

Main Results:

• Enrollment was discontinued due to futility for the pooled antiplatelet group versus control.
• The median for organ support-free days was 7 in both antiplatelet and control groups (OR, 1.02; 95.7% probability of futility).
• Major bleeding occurred in 2.1% of the antiplatelet group versus 0.4% in the control group (adjusted OR, 2.97; 99.4% probability of harm).

Conclusions:

• Antiplatelet therapy demonstrated a low likelihood of improving organ support-free days in critically ill COVID-19 patients.
• While survival to discharge showed a trend towards benefit with antiplatelets (97% probability of efficacy), this was not statistically significant for the primary outcome.
• Increased risk of major bleeding was observed with antiplatelet therapy, suggesting potential harm.