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Updated: Sep 22, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Dipyridamole does not have any additive effect on the prevention of COVID-19 coagulopathy
Sevgi Kalayoglu Besisik1, Murat Ozbalak1, Yavuz Burak Tor2
1Department of Internal Medicine, Division of Hematology, Istanbul Medical Faculty, Istanbul University Istanbul, Turkey.
Objective:
Severe acute respiratory syndrome (SARS) coronavirus 2 (SaRS-Cov-2) associated respiratory disease (COVID-19), announced as a pandemic, is a multisystem syndrome. SARS-CoV-2 directly infects and damages vascular endothelial cells, which leads to microvascular dysfunction and promotes a procoagulant state. Dipyridamole (DP) acts as a reversible phosphodiesterase inhibitor and is used mainly as an antiplatelet agent. It is hypothetised that it has possible activities in COVID-19.
Design And Methodology:
We report our retrospective, real-world results of DP added to low-molecular weight heparin (LMWH) in the treatment of 462 clinically diagnosed and hospitalized COVID-19 patients. We compared anticoagulation with and without DP addition with no administration of anticoagulation in the same time frame. The primary outcome was proven or highly suspected coagulopathy within 30 days of hospitalization.
Results:
Definitive coagulopathy has been diagnosed in 3 (3.5%) of 85 LMWH administered patients and 7 (2.13%) of 328 DP + LMWH received patients (P=0.456). Five cases with definitive coagulopathy were not initiated any anticoagulation at the time of the event. The multivariate analysis showed that DP addition to the anticoagulant approach did not have any impact on the risk of demonstrated coagulopathy and highly-suspected coagulopathy.
Conclusion:
We think that our clinical experience is valuable in showing the real-life results of DP + LMWH treatment in COVID-19. This approach did not affect the coagulopathy rate. Our data did also not document an additive effect of DP in the COVID-19 outcome. Prospective controlled trials would give more convincing results regarding the role of DP in COVID-19 endothelial dysfunction and clinical outcome.
Insights
Dipyridamole (DP) added to low-molecular weight heparin (LMWH) did not reduce coagulopathy in hospitalized COVID-19 patients. This real-world study found no significant difference in coagulopathy rates with or without DP. Further trials are needed to confirm DP
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- COVID-19 is a multisystem syndrome impacting vascular endothelial cells, leading to microvascular dysfunction and a procoagulant state.
- Dipyridamole (DP) is a phosphodiesterase inhibitor with antiplatelet properties, hypothesized to have potential benefits in COVID-19 treatment.
- Endothelial dysfunction and coagulopathy are significant concerns in severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) infection.
Purpose of the Study:
- To evaluate the real-world effectiveness of adding dipyridamole (DP) to low-molecular weight heparin (LMWH) in treating hospitalized COVID-19 patients.
- To compare coagulopathy rates in COVID-19 patients treated with LMWH alone versus LMWH plus DP.
- To assess the impact of DP on the risk of coagulopathy in COVID-19 patients.
Main Methods:
- Retrospective analysis of 462 hospitalized COVID-19 patients.
- Comparison of three groups: no anticoagulation, LMWH, and LMWH + DP.
- Primary outcome: diagnosis of coagulopathy within 30 days of hospitalization.
Main Results:
- Coagulopathy occurred in 3.5% of patients on LMWH and 2.13% on LMWH + DP (P=0.456).
- No significant difference in coagulopathy rates was observed between the groups.
- Multivariate analysis indicated DP addition did not impact the risk of coagulopathy.
Conclusions:
- The addition of DP to LMWH in COVID-19 patients did not alter coagulopathy rates.
- Clinical experience suggests DP does not provide an additive benefit for coagulopathy in COVID-19.
- Prospective controlled trials are recommended to definitively determine DP's role in COVID-19 endothelial dysfunction and outcomes.
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