Pre-Hospital Antiplatelet Medication Use on COVID-19 Disease Severity

Pan, Darren; Ip, Ada; Zhan, Serena; Wasserman, Isaac; Snyder, Daniel J.; Agathis, Alexandra Z.; Shamapant, Nikhil; Yang, Jeong Yun; Pai, Akila; Mazumdar, Madhu; Poor, Hooman

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.