Effect of P2Y12 Inhibitors on Organ Support–Free Survival in Critically Ill Patients Hospitalized for COVID-19
Male
Ticagrelor
Medical Sciences
COVID-19; Critical Illness; Hemorrhage; Hospital Mortality; Humans; Male; Middle Aged; Ticagrelor
Critical Illness
ICTS (Institute of Clinical and Translational Sciences)
150
610
COVID-19
Hemorrhage
Middle Aged
Medical Specialties
Medicine and Health Sciences
Humans
Public Health
Hospital Mortality
Purinergic P2Y Receptor Agonists
Original Investigation
DOI:
10.1001/jamanetworkopen.2023.14428
Publication Date:
2023-05-25T15:33:29Z
AUTHORS (343)
ABSTRACT
Importance Platelet activation is a potential therapeutic target in patients with COVID-19. Objective To evaluate the effect of P2Y12 inhibition among critically ill hospitalized for Design, Setting, and Participants This international, open-label, adaptive platform, 1:1 randomized clinical trial included (requiring intensive care–level support) Patients were enrolled between February 26, 2021, through June 22, 2022. Enrollment was discontinued on 2022, by leadership coordination study sponsor given marked slowing enrollment rate patients. Intervention randomly assigned to receive inhibitor or no (usual care) 14 days until hospital discharge, whichever sooner. Ticagrelor preferred inhibitor. Main Outcomes Measures The primary outcome organ support–free days, evaluated an ordinal scale that combined in-hospital death and, participants who survived number free cardiovascular respiratory support up day 21 index hospitalization. safety major bleeding, as defined International Society Thrombosis Hemostasis. Results At time termination, 949 (median [IQR] age, 56 [46-65] years; 603 male [63.5%]) had been assigned, 479 group 470 usual care. In group, ticagrelor used 372 (78.8%) clopidogrel 100 (21.2%). estimated adjusted odds ratio (AOR) 1.07 (95% credible interval, 0.85-1.33). posterior probability superiority (defined OR > 1.0) 72.9%. Overall, 354 (74.5%) 339 (72.4%) care discharge AOR, 1.15; 95% 0.84-1.55; superiority, 80.8%). Major bleeding occurred 13 (2.7%) (2.8%) group. mortality at 90 25.5% 27.0% (adjusted hazard ratio, 0.96; CI, 0.76-1.23; P = .77). Conclusions Relevance this COVID-19, treatment did not improve alive support. use increase compared These data do routine Trial Registration ClinicalTrials.gov Identifier: NCT04505774
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