Background COVID-19 is a respiratory disease that results in a prothrombotic state manifesting as thrombotic, microthrombotic and thromboembolic events. As a result, several antithrombotic modalities have been implicated in the treatment of this disease. This study aimed to identify if therapeutic anticoagulation (TAC) or concurrent use of antiplatelet and anticoagulants was associated with an improved outcome in this patient population. Methods A retrospective observational cohort study of adult patients admitted to a single university hospital for COVID-19 infection was performed. The primary outcome was a composite of in-hospital mortality, intensive care unit (ICU) admission or the need for mechanical ventilation. The secondary outcomes were each of the components of the primary outcome, in-hospital mortality, ICU admission, or the need for mechanical ventilation. Results 242 patients were included in the study and divided into four subgroups: Therapeutic anticoagulation (TAC), prophylactic anticoagulation+antiplatelet (PACAP), TAC+antiplatelet (TACAP) and prophylactic anticoagulation (PAC) which was the reference for comparison. Multivariable Cox regression analysis and propensity matching were done and showed when compared with PAC, TACAP and TAC were associated with less in-hospital all-cause mortality with an adjusted HR (aHR) of 0.113 (95% CI 0.028 to 0.449) and 0.126 (95% CI 0.028 to 0.528), respectively. The number needed to treat in both subgroups was 11. Furthermore, PACAP was associated with a reduced risk of invasive mechanical ventilation with an aHR of 0.07 (95% CI 0.014 to 0.351). However, the was no statistically significant difference in the occurrence of major or minor bleeds, ICU admission or the composite outcome of in-hospital mortality, ICU admission or the need for mechanical ventilation. Conclusion The use of combined anticoagulant and antiplatelet agents or TAC alone in hospitalised patients with COVID-19 was associated with a better outcome in comparison to PAC alone without an increase in the risk of major and minor bleeds. Sufficiently powered randomised controlled trials are needed to further evaluate the safety and efficacy of combining antiplatelet and anticoagulants agents or using TAC in the management of patients with COVID-19 infection. Data are available upon reasonable request. All data relevant to the study are included in the article and are available on reasonable request from the last author GG.

中文翻译：

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抗凝和抗血小板联合治疗与 COVID-19 住院患者的预后改善相关：一项倾向匹配队列研究

背景 COVID-19 是一种导致血栓前状态的呼吸系统疾病，表现为血栓形成、微血栓形成和血栓栓塞事件。因此，几种抗血栓形成方式已与该疾病的治疗有关。本研究旨在确定治疗性抗凝 (TAC) 或同时使用抗血小板和抗凝剂是否与该患者群体的预后改善相关。方法 对因 COVID-19 感染而入住一所大学医院的成年患者进行了一项回顾性观察队列研究。主要结果是院内死亡率、重症监护病房 (ICU) 入院或机械通气需求的综合结果。次要结果是主要结果的每个组成部分、住院死亡率、入住 ICU、或需要机械通风。结果 242例患者纳入研究，分为治疗性抗凝（TAC）、预防性抗凝+抗血小板（PACAP）、TAC+抗血小板（TACAP）和预防性抗凝（PAC）4个亚组，作为比较参考。多变量 Cox 回归分析和倾向匹配表明，与 PAC 相比，TACAP 和 TAC 与较低的院内全因死亡率相关，调整后的 HR (aHR) 为 0.113（95% CI 0.028 至 0.449）和 0.126（ 95% CI 0.028 至 0.528)，分别。两个亚组需要治疗的人数均为 11。此外，PACAP 与有创机械通气风险降低相关，aHR 为 0.07（95% CI 0.014 至 0.351）。然而，大出血或小出血的发生率、ICU 入住率或住院死亡率、ICU 入住率或机械通气需求的复合结果均无统计学差异。结论 与单独使用 PAC 相比，在 COVID-19 住院患者中使用联合抗凝剂和抗血小板药物或单独使用 TAC 与更好的结果相关，而不会增加大出血和小出血的风险。需要有足够效力的随机对照试验来进一步评估联合抗血小板和抗凝剂或使用 TAC 治疗 COVID-19 感染患者的安全性和有效性。可应合理要求提供数据。与研究相关的所有数据都包含在文章中，可应最后一位作者 GG 的合理要求提供。