Related Experiment Video
Updated: Jul 4, 2025
Author Spotlight: Evaluating the Adjuvant Efficacy and Safety of Angong Niuhuang Pill in Viral Encephalitis Treatment
Published on: April 19, 2024
Effect of antiplatelet therapy after COVID-19 diagnosis: A systematic review with meta-analysis and trial sequential
Hong Duo1, Mengying Jin2, Yanwei Yang3
1Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, Hubei Key Laboratory of Medical Technology on Transplantation, Wuhan, China.
Insights
Antiplatelet therapy in COVID-19 patients does not significantly reduce all-cause death but increases major bleeding risk. More randomized clinical trials are needed to clarify the benefits and risks of antiplatelet agents in COVID-19 treatment.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Coronavirus disease 2019 (COVID-19) is associated with increased thrombotic risk.
- The role of antiplatelet therapy in managing COVID-19 remains debated.
- This study investigates the efficacy and safety of antiplatelet agents in COVID-19 patients.
Approach:
- A systematic review and meta-analysis of randomized clinical trials (RCTs) was conducted.
- Searches were performed across major databases (PubMed, EMBASE, Cochrane, Web of Science) up to February 1, 2023.
- PRISMA guidelines were followed, using random-effects models for pooled analysis.
Key Points:
- Analysis of 5 RCTs involving 17,950 COVID-19 patients found no significant reduction in all-cause mortality with antiplatelet therapy (RR 0.94, 95% CI 0.83-1.05).
- Antiplatelet therapy was associated with a significantly increased risk of major bleeding (RR 1.81, 95% CI 1.09-3.00).
- Sequential analysis indicated insufficient evidence to confirm or refute benefits, suggesting the need for further RCTs.
Conclusions:
- Current evidence does not support the routine use of antiplatelet agents for COVID-19 patients regarding mortality benefit.
- A significant increase in major bleeding events is observed with antiplatelet therapy.
- Further large-scale, well-designed randomized clinical trials are essential to definitively establish the role of antiplatelet agents in COVID-19 management.
Background:
Coronavirus disease 2019 (COVID-19) may predispose patients to thrombotic disease in the venous and arterial circulations.
Methods:
Based on the current debate on antiplatelet therapy in COVID-19 patients, we performed a systematic review and meta-analysis to investigate the effect of antiplatelet treatments. We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science on February 1, 2023, and only included Randomized clinical trials. The study followed PRISMA guidelines and used Random-effects models to estimate the pooled percentage and its 95% CI.
Results:
Five unique eligible studies were included, covering 17,950 patients with COVID-19. The result showed no statistically significant difference in the relative risk of all-cause death in antiplatelet therapy versus non-antiplatelet therapy (RR 0.94, 95% CI, 0.83-1.05, P = 0.26, I2 = 32%). Compared to no antiplatelet therapy, patients who received antiplatelet therapy had a significantly increased relative risk of major bleeding (RR 1.81, 95%CI 1.09-3.00, P = 0.02, I2 = 16%). The sequential analysis suggests that more RCTs are needed to draw more accurate conclusions. This systematic review and meta-analysis revealed that the use of antiplatelet agents exhibited no significant benefit on all-cause death, and the upper bound of the confidence interval on all-cause death (RR 95% CI, 0.83-1.05) suggested that it was unlikely to be a substantiated harm risk associated with this treatment. However, evidence from all RCTs suggested a high risk of major bleeding in antiplatelet agent treatments.
Conclusion:
According to the results of our sequential analysis, there is not enough evidence available to support or negate the use of antiplatelet agents in COVID-19 cases. The results of ongoing and future well-designed, large, randomized clinical trials are needed.
Related Concept Videos
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:25Antianginal Drugs: Calcium Channel Blockers and Ranolazine
CCBs, a diverse class that includes dihydropyridines (nifedipine) and diphenylalkylamines (verapamil and diltiazem), exert their effect by blocking calcium channels in cardiac and smooth muscle cells. This...
01:22Formation of the Platelet Plug
As the injured blood vessel contracts, endothelial cells undergo contraction, revealing collagen fibers in the basement membrane and underlying connective tissue. Furthermore, the plasma membrane of endothelial cells becomes adhesive, preparing the site for platelet adhesion. Platelets...
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins