COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Treatment Matli K, Farah R, Maalouf M, et al. Role of combining anticoagulant and antiplatelet agents in COVID-19 treatment: a rapid review. Open Heart. 2021 Jun;8(1):e001628. doi: 10.1136/openhrt-2021-001628.
Abstract

Although primarily affecting the respiratory system, COVID-19 causes multiple organ damage. One of its grave consequences is a prothrombotic state that manifests as thrombotic, microthrombotic and thromboembolic events. Therefore, understanding the effect of antiplatelet and anticoagulation therapy in the context of COVID-19 treatment is important. The aim of this rapid review was to highlight the role of thrombosis in COVID-19 and to provide new insights on the use of antithrombotic therapy in its management. A rapid systematic review was performed using preferred reporting items for systematic reviews. Papers published in English on antithrombotic agent use and COVID-19 complications were eligible. Results showed that the use of anticoagulants increased survival and reduced thromboembolic events in patients. However, despite the use of anticoagulants, patients still suffered thrombotic events likely due to heparin resistance. Data on antiplatelet use in combination with anticoagulants in the setting of COVID-19 are quite scarce. Current side effects of anticoagulation therapy emphasise the need to update treatment guidelines. In this rapid review, we address a possible modulatory role of antiplatelet and anticoagulant combination against COVID-19 pathogenesis. This combination may be an effective form of adjuvant therapy against COVID-19 infection. However, further studies are needed to elucidate potential risks and benefits associated with this combination.

Ratings
Discipline / Specialty Area Score
Emergency Medicine
Hospital Doctor/Hospitalists
Internal Medicine
Hemostasis and Thrombosis
Infectious Disease
Comments from MORE raters

Emergency Medicine rater

Emergency rooms are seeing more COVID-19 positive patients who thanks to mass vaccination and better understanding of disease course, may be able to be treated as outpatient. A major sticking point however, is whether these patients who were treated inpatient last year, and have at least received prophylactic standard dosing AC, will benefit from going home on such regimens.

Hemostasis and Thrombosis rater

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Hospital Doctor/Hospitalists rater

Nice review but as they say, there is a lot of uncertainty still, so this doesn’t really resolve the question. Still, this is a timely reminder to at least consider both anti platelet and anticoagulation.

Infectious Disease rater

The idea of using antiplatelet adjunctive therapy for COVID-19 to reduce the risk for thrombosis is interesting. However, as the article appropriately notes, more study is needed to see whether the benefits outweigh the risks.