Objective

To evaluate the association between pre-hospitalization antiplatelet medication use and COVID-19 disease severity.

Design

Retrospective cohort study.

Setting

Inpatient units at The Mount Sinai Hospital.

Patients

Adults age ≥18 admitted between March 1, 2020 and April 9, 2020 with confirmed COVID-19 infection with at least 28 days follow-up.

Measurements

We captured baseline demographic, pre-hospitalization antiplatelet medication use, and clinical encounter data for all patients who met inclusion criteria. The primary endpoint was peak score on a 6-point modified ordinal scale (MOS), which is based on World Health Organization blueprint R&S groups, used to grade severity of illness through clinical outcomes of interest. Scores indicate the following: 1 – COVID-19 infection not requiring hospitalization, 2 – requiring hospitalization but not supplemental oxygen, 3 – hospitalization requiring supplemental oxygen, 4 – hospitalization requiring high-flow nasal cannula (HFNC) or non-invasive positive pressure ventilation (NIPPV), 5 – hospitalization requiring intubation or extracorporeal membrane oxygenation (ECMO), 6 – death. Multivariable adjusted partial proportional odds model (PPOM) was performed to examine the association between pre-hospitalization antiplatelet medication use and likelihood of each MOS score.

Main Results

Of 762 people admitted with COVID-19, 239 (31.4%) used antiplatelet medications pre-hospitalization while 523 (68.6%) did not. Antiplatelet users were older and had more co-morbidities at baseline. Before adjusting for covariates, patients who used antiplatelet medications pre-hospitalization were more likely than non-users to have peak MOS score 6 (death, OR 1.75, 95% CI 1.21–2.52), peak MOS score ≥5 (intubation/ECMO or death, OR 1.4, 95% CI 1.00–1.98) and peak MOS score ≥4 (HFNC, NIPPV, intubation/ECMO or death, OR 1.40, 95% CI 1.01–1.94). On multivariable adjusted PPOM analysis controlling for 13 covariates, there were no longer any significant differences in peak MOS scores between users and non-users.

Conclusions

After adjusting for covariates, pre-hospital antiplatelet use was not associated with COVID-19 severity in hospitalized patients.

中文翻译：

---

院前抗血小板药物使用对 COVID-19 疾病严重程度的影响

客观的

评估入院前抗血小板药物使用与 COVID-19 疾病严重程度之间的关联。

设计

回顾性队列研究。

环境

西奈山医院的住院部。

患者

在 2020 年 3 月 1 日至 2020 年 4 月 9 日期间入院并确诊感染 COVID-19 并至少随访 28 天的 18 岁以上成人。

测量

我们收集了符合纳入标准的所有患者的基线人口统计学、入院前抗血小板药物使用和临床就诊数据。主要终点是基于世界卫生组织蓝图 R&S 组的 6 分修正序数量表 (MOS) 的峰值得分，用于通过感兴趣的临床结果对疾病的严重程度进行分级。分数表示以下内容：1 – COVID-19 感染不需要住院，2 – 需要住院但不需要补充氧气，3 – 住院需要补充氧气，4 – 住院需要高流量鼻插管 (HFNC) 或无创正压通气(NIPPV)，5 – 需要插管或体外膜肺氧合 (ECMO) 的住院治疗，6 – 死亡。

主要结果

在因 COVID-19 入院的 762 人中，239 人 (31.4%) 在入院前使用了抗血小板药物，而 523 人 (68.6%) 没有。抗血小板药物使用者年龄较大，并且在基线时有更多的合并症。在调整协变量之前，住院前使用抗血小板药物的患者比未使用抗血小板药物的患者更有可能出现峰值 MOS 评分 6（死亡，OR 1.75，95% CI 1.21-2.52），峰值 MOS 评分≥5（插管/ECMO 或死亡，OR 1.4，95% CI 1.00–1.98）和 MOS 峰值评分≥4（HFNC、NIPPV、插管/ECMO 或死亡，OR 1.40，95% CI 1.01–1.94）。在控制 13 个协变量的多变量调整 PPOM 分析中，用户和非用户之间的峰值 MOS 分数不再有任何显着差异。

结论

调整协变量后，院前抗血小板药物的使用与住院患者的 COVID-19 严重程度无关。