Kanagaratnam, Prapa, Francis, Darrel P, Chamie, Daniel, Coyle, Clare, Marynina, Alena, Katritsis, George, Paiva, Patricia, Szigeti, Matyas, Cole, Graham, Nunes, David de Andrade et al (show 30 more authors)
(2023)
A randomized controlled trial to investigate the use of acute coronary syndrome therapy in patients hospitalized with COVID-19: the COVID-19 Acute Coronary Syndrome trial.
JOURNAL OF THROMBOSIS AND HAEMOSTASIS, 21 (8).
pp. 2213-2222.
Abstract
<h4>Background</h4>Patients hospitalized with COVID-19 suffer thrombotic complications. Risk factors for poor outcomes are shared with coronary artery disease.<h4>Objectives</h4>To investigate the efficacy of an acute coronary syndrome regimen in patients hospitalized with COVID-19 and coronary disease risk factors.<h4>Methods</h4>A randomized controlled, open-label trial across acute hospitals (United Kingdom and Brazil) added aspirin, clopidogrel, low-dose rivaroxaban, atorvastatin, and omeprazole to standard care for 28 days. Primary efficacy and safety outcomes were 30-day mortality and bleeding. The key secondary outcome was a daily clinical status (at home, in hospital, on intensive therapy unit admission, or death).<h4>Results</h4>Three hundred twenty patients from 9 centers were randomized. The trial terminated early due to low recruitment. At 30 days, there was no significant difference in mortality (intervention vs control, 11.5% vs 15%; unadjusted odds ratio [OR], 0.73; 95% CI, 0.38-1.41; p = .355). Significant bleeds were infrequent and were not significantly different between the arms (intervention vs control, 1.9% vs 1.9%; p > .999). Using a Bayesian Markov longitudinal ordinal model, it was 93% probable that intervention arm participants were more likely to transition to a better clinical state each day (OR, 1.46; 95% credible interval [CrI], 0.88-2.37; Pr [beta > 0], 93%; adjusted OR, 1.50; 95% CrI, 0.91-2.45; Pr [beta > 0], 95%) and median time to discharge to home was 2 days shorter (95% CrI, -4 to 0; 2% probability that it was worse).<h4>Conclusion</h4>Acute coronary syndrome treatment regimen was associated with a reduction in the length of hospital stay without an excess in major bleeding. A larger trial is needed to evaluate mortality.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | anticoagulant agent, antiplatelet agent, COVID-19 infection, ischemic heart disease, randomized, controlled trial, thrombosis |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 07 Jul 2023 15:08 |
| Last Modified: | 09 Sep 2023 00:15 |
| DOI: | 10.1016/j.jtha.2023.04.045 |
| Open Access URL: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10204... |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3171545 |
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