Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19
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DOI:
10.1001/jama.2022.2910
Publication Date:
2022-03-22T09:31:02Z
AUTHORS (1805)
ABSTRACT
<h3>Importance</h3> The efficacy of antiplatelet therapy in critically ill patients with COVID-19 is uncertain. <h3>Objective</h3> To determine whether improves outcomes for adults COVID-19. <h3>Design, Setting, and Participants</h3> In an ongoing adaptive platform trial (REMAP-CAP) testing multiple interventions within therapeutic domains, 1557 adult were enrolled between October 30, 2020, June 23, 2021, from 105 sites 8 countries followed up 90 days (final follow-up date: July 26, 2021). <h3>Interventions</h3> Patients randomized to receive either open-label aspirin (n = 565), a P2Y12 inhibitor 455), or no (control; n 529). Interventions continued the hospital maximum 14 addition anticoagulation thromboprophylaxis. <h3>Main Outcomes Measures</h3> primary end point was organ support–free (days alive free intensive care unit–based respiratory cardiovascular support) 21 days, ranging −1 any death (censored at days) 22 survivors support. There 13 secondary outcomes, including survival discharge major bleeding days. analysis bayesian cumulative logistic model. An odds ratio (OR) greater than 1 represented improved survival, more both. Efficacy defined as 99% posterior probability OR 1. Futility 95% less 1.2 vs control. Intervention equivalence 90% that (compared each other) 1/1.2 2 noncontrol interventions. <h3>Results</h3> groups met predefined criteria statistically pooled further analysis. Enrollment discontinued after prespecified criterion futility group compared Among randomized, withdrew consent 1549 completed (median age, 57 years; 521 [33.6%] female). median 7 (IQR, 16) both control (median-adjusted OR, 1.02 [95% credible interval {CrI}, 0.86-1.23]; 95.7% futility). proportions surviving 71.5% (723/1011) 67.9% (354/521) groups, respectively 1.27 CrI, 0.99-1.62]; adjusted absolute difference, 5% −0.2% 9.5%]; 97% efficacy). survivors, groups. Major occurred 2.1% 0.4% (adjusted 2.97 1.23-8.28]; risk increase, 0.8% 0.1%-2.7%]; 99.4% harm). <h3>Conclusions Relevance</h3> COVID-19, treatment agent, had low likelihood providing improvement number <h3>Trial Registration</h3> ClinicalTrials.gov Identifier:NCT02735707
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