Research Article
BibTex RIS Cite

Effect Of Long-Term Use Of Antithrombotics And Statins On COVID-19 Mortality And Clinical Severity

Year 2024, Volume: 2 Issue: 2, 67 - 74, 29.08.2024
https://doi.org/10.62425/rtpharma.1534162

Abstract

Objective: Coronavirus Disease-2019 (COVID-19), has affected the whole world and is still an important disease with its mutations. In our study, we aimed to evaluate the effects of antithrombotic agents [acetylsalicylic acid (ASA), P2Y12 inhibitors, oral anticoagulants (OACs)] and statin treatments used before hospitalization on COVID-19 mortality and clinical severity.
Methods: A retrospective study was conducted on 5577 patients hospitalized with positive swab tests or findings consistent with COVID-19 on computed tomography. The 6-month mortality, in-hospital mortality, need for intensive care and intubation, and recurrent hospitalization outcomes of patients receiving chronic ASA (n=1210), P2Y12 inhibitors (n=357), OACs (n=1192), and statin (n=607) treatment were evaluated.
Results: The 6-month mortality rate was 13.5% (n=754), in-hospital mortality rate was 11.2% (n=627), the rate of admission to the intensive care unit was 16.1% (n=897), the need for intubation was 8.8% (n=493), and the rate of recurrent hospitalization was 10.4% (n=579). ASA and OACs reduced all outcomes. P2Y12 inhibitors provided benefit in other endpoints except intubation. Statins used before hospitalization did not provide a statistically significant decrease in 6-month mortality (p: 0.06), but were associated with a decrease in the rates of in-hospital mortality, need for intensive care, recurrent hospitalization, and intubation.
Conclusion: We found that long-term ASA, P2Y12 inhibitors, OACs and statin treatments used before hospitalization in patients hospitalized with COVID-19, reduced COVID-19 mortality and clinical severity. We think that these treatments may be beneficial in selected patient groups where post-COVID effects are observed.

Ethical Statement

Ethics committee approval was received for this study from the ethics committee of Erzurum BEAH KAEK (Date: January 18, 2021, Number: 2021/02-33).

References

  • Abou-Ismail, M. Y., Diamond, A., Kapoor, S., Arafah, Y., & Nayak, L. (2020). The hypercoagulable state in COVID-19: Incidence, pathophysiology, and management. Thrombosis Research, 194, 101-115. https://doi.org/10.1016/j.thromres.2020.06.029
  • Bikdeli, B., Madhavan, M. V., Jimenez, D., Chuich, T., Dreyfus, I., Driggin, E., … Right Ventricular, F. (2020). COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review. Journal of the American College of Cardiology, 75(23), 2950-2973. https://doi.org/10.1016/j.jacc.2020.04.031
  • Boyle, A. J., Di Gangi, S., Hamid, U. I., Mottram, L. J., McNamee, L., White, G., … McAuley, D. F. (2015). Aspirin therapy in patients with acute respiratory distress syndrome (ARDS) is associated with reduced intensive care unit mortality: a prospective analysis. Critical Care, 19(1), 109. https://doi.org/10.1186/s13054-015-0846-4
  • Butt, J. H., Gerds, T. A., Schou, M., Kragholm, K., Phelps, M., Havers-Borgersen, E., … Fosbol, E. L. (2020). Association between statin use and outcomes in patients with coronavirus disease 2019 (COVID-19): a nationwide cohort study. BMJ Open, 10(12), e044421. https://doi.org/10.1136/bmjopen-2020-044421
  • Cariou, B., Goronflot, T., Rimbert, A., Boullu, S., Le May, C., Moulin, P., … investigators, C. (2021). Routine use of statins and increased COVID-19 related mortality in inpatients with type 2 diabetes: Results from the CORONADO study. Diabetes & Metabolism, 47(2), 101202. https://doi.org/10.1016/j.diabet.2020.10.001
  • Cucinotta, D., & Vanelli, M. (2020). WHO Declares COVID-19 a Pandemic. Acta Biomedica, 91(1), 157-160. https://doi.org/10.23750/abm.v91i1.9397
  • Du, F., Jiang, P., He, S., Song, D., & Xu, F. (2018). Antiplatelet Therapy for Critically Ill Patients: A Pairwise and Bayesian Network Meta-Analysis. Shock, 49(6), 616-624. https://doi.org/10.1097/SHK.0000000000001057
  • Frohlich, G. M., Jeschke, E., Eichler, U., Thiele, H., Alhariri, L., Reinthaler, M., … Gunster, C. (2021). Impact of oral anticoagulation on clinical outcomes of COVID-19: a nationwide cohort study of hospitalized patients in Germany. Clinical Research in Cardiology, 110(7), 1041-1050. https://doi.org/10.1007/s00392-020-01783-x
  • Glatthaar-Saalmuller, B., Mair, K. H., & Saalmuller, A. (2017). Antiviral activity of aspirin against RNA viruses of the respiratory tract-an in vitro study. Influenza and Other Respiratory Viruses, 11(1), 85-92. https://doi.org/10.1111/irv.12421
  • Grundy, S. M., Stone, N. J., Bailey, A. L., Beam, C., Birtcher, K. K., Blumenthal, R. S., … Yeboah, J. (2019). 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 73(24), 3168-3209. https://doi.org/10.1016/j.jacc.2018.11.002
  • Hariyanto, T. I., & Kurniawan, A. (2020). Statin therapy did not improve the in-hospital outcome of coronavirus disease 2019 (COVID-19) infection. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 14(6), 1613-1615. https://doi.org/10.1016/j.dsx.2020.08.023
  • Hariyanto, T. I., & Kurniawan, A. (2021). Statin and outcomes of coronavirus disease 2019 (COVID-19): A systematic review, meta-analysis, and meta-regression. Nutrition, Metabolism & Cardiovascular Diseases, 31(6), 1662-1670. https://doi.org/10.1016/j.numecd.2021.02.020
  • Hojyo, S., Uchida, M., Tanaka, K., Hasebe, R., Tanaka, Y., Murakami, M., & Hirano, T. (2020). How COVID-19 induces cytokine storm with high mortality. Inflammation and Regeneration, 40, 37. https://doi.org/10.1186/s41232-020-00146-3
  • Ikonomidis, I., Andreotti, F., Economou, E., Stefanadis, C., Toutouzas, P., & Nihoyannopoulos, P. (1999). Increased proinflammatory cytokines in patients with chronic stable angina and their reduction by aspirin. Circulation, 100(8), 793-798. https://doi.org/10.1161/01.cir.100.8.793
  • Kow, C. S., & Hasan, S. S. (2020). Meta-analysis of Effect of Statins in Patients with COVID-19. American Journal of Cardiology, 134, 153-155. https://doi.org/10.1016/j.amjcard.2020.08.004
  • Lippi, G., Plebani, M., & Henry, B. M. (2020). Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. Clinical Chimica Acta, 506, 145-148. https://doi.org/10.1016/j.cca.2020.03.022
  • Madjid, M., Safavi-Naeini, P., Solomon, S. D., & Vardeny, O. (2020). Potential Effects of Coronaviruses on the Cardiovascular System: A Review. JAMA Cardiology, 5(7), 831-840. https://doi.org/10.1001/jamacardio.2020.1286
  • Malas, M. B., Naazie, I. N., Elsayed, N., Mathlouthi, A., Marmor, R., & Clary, B. (2020). Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis. EClinicalMedicine, 29, 100639. https://doi.org/10.1016/j.eclinm.2020.100639
  • Moores, L. K., Tritschler, T., Brosnahan, S., Carrier, M., Collen, J. F., Doerschug, K., … Wells, P. (2020). Prevention, Diagnosis, and Treatment of VTE in Patients With Coronavirus Disease 2019: CHEST Guideline and Expert Panel Report. Chest, 158(3), 1143-1163. https://doi.org/10.1016/j.chest.2020.05.559
  • Nopp, S., Moik, F., Jilma, B., Pabinger, I., & Ay, C. (2020). Risk of venous thromboembolism in patients with COVID-19: A systematic review and meta-analysis. Research and Practice in Thrombosis and Haemostasis, 4(7), 1178-1191. https://doi.org/10.1002/rth2.12439
  • Pal, R., Banerjee, M., Yadav, U., & Bhattacharjee, S. (2022). Statin use and clinical outcomes in patients with COVID-19: An updated systematic review and meta-analysis. Postgraduate Medical Journal, 98(1159), 354-359. https://doi.org/10.1136/postgradmedj-2020-139172
  • Panka, B. A., de Grooth, H. J., Spoelstra-de Man, A. M., Looney, M. R., & Tuinman, P. R. (2017). Prevention or Treatment of ARDS With Aspirin: A Review of Preclinical Models and Meta-Analysis of Clinical Studies. Shock, 47(1), 13-21. https://doi.org/10.1097/SHK.0000000000000745
  • Pillinger, M. H., Capodici, C., Rosenthal, P., Kheterpal, N., Hanft, S., Philips, M. R., & Weissmann, G. (1998). Modes of action of aspirin-like drugs: salicylates inhibit ERK activation and integrin-dependent neutrophil adhesion. Proceedings of the National Academy of Sciences of the United States of America, 95(24), 14540-14545. https://doi.org/10.1073/pnas.95.24.14540
  • Shah, W., Hillman, T., Playford, E. D., & Hishmeh, L. (2021). Managing the long term effects of COVID-19: summary of NICE, SIGN, and RCGP rapid guideline. BMJ, 372, n136. https://doi.org/10.1136/bmj.n136
  • Spiegelenberg, J. P., van Gelder, M., Maas, M. L., Hovens, M. M. C., Esselink, A., Dofferhoff, A. S. M., … Leentjens, J. (2021). Prior use of therapeutic anticoagulation does not protect against COVID-19 related clinical outcomes in hospitalized patients: A propensity score-matched cohort study. British Journal of Clinical Pharmacology, 87(12), 4839-4847. https://doi.org/10.1111/bcp.14877
  • Tang, N., Li, D., Wang, X., & Sun, Z. (2020). Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. Journal of Thrombosis and Haemostasis, 18(4), 844-847. https://doi.org/10.1111/jth.14768
  • Task Force for the management of, C.-o. t. E. S. o. C. (2022). European Society of Cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1-epidemiology, pathophysiology, and diagnosis. European Heart Journal, 43(11), 1033-1058. https://doi.org/10.1093/eurheartj/ehab696
  • Testa, S., Paoletti, O., Giorgi-Pierfranceschi, M., & Pan, A. (2020). Switch from oral anticoagulants to parenteral heparin in SARS-CoV-2 hospitalized patients. Internal and Emergency Medicine, 15(5), 751-753. https://doi.org/10.1007/s11739-020-02331-1
  • Varga, Z., Flammer, A. J., Steiger, P., Haberecker, M., Andermatt, R., Zinkernagel, A. S., … Moch, H. (2020). Endothelial cell infection and endotheliitis in COVID-19. The Lancet, 395(10234), 1417-1418. https://doi.org/10.1016/S0140-6736(20)30937-5
  • Wang, L., Li, H., Gu, X., Wang, Z., Liu, S., & Chen, L. (2016). Effect of Antiplatelet Therapy on Acute Respiratory Distress Syndrome and Mortality in Critically Ill Patients: A Meta-Analysis. PLoS One, 11(5), e0154754. https://doi.org/10.1371/journal.pone.0154754
  • World Health Organization. (2024). Number of COVID-19 cases reported to WHO. Retrieved from https://data.who.int/dashboards/covid19/cases
  • Yau, J. W., Teoh, H., & Verma, S. (2015). Endothelial cell control of thrombosis. BMC Cardiovascular Disorders, 15, 130. https://doi.org/10.1186/s12872-015-0124-z
  • Zaim, S., Chong, J. H., Sankaranarayanan, V., & Harky, A. (2020). COVID-19 and Multiorgan Response. Current Problems in Cardiology, 45(8), 100618. https://doi.org/10.1016/j.cpcardiol.2020.100618
There are 33 citations in total.

Details

Primary Language English
Subjects Medical Pharmacology
Journal Section Research Articles
Authors

Emrah Aksakal 0000-0001-5765-4281

Selim Aydemir 0000-0001-6654-2521

Faruk Aydınyılmaz 0000-0003-1088-3559

Murat Özmen This is me 0000-0002-6237-1398

Publication Date August 29, 2024
Submission Date July 12, 2024
Acceptance Date August 11, 2024
Published in Issue Year 2024 Volume: 2 Issue: 2

Cite

APA Aksakal, E., Aydemir, S., Aydınyılmaz, F., Özmen, M. (2024). Effect Of Long-Term Use Of Antithrombotics And Statins On COVID-19 Mortality And Clinical Severity. Recent Trends in Pharmacology, 2(2), 67-74. https://doi.org/10.62425/rtpharma.1534162