A randomized controlled trial to investigate the use of acute coronary syndrome therapy in patients hospitalized with COVID-19: the COVID-19 Acute Coronary Syndrome trial
J. thromb. haemost
; 21: 2213-2222, Apr. 2023. graf, ilus, tab
Article
in English
| CONASS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP
| ID: biblio-1435649
Responsible library:
BR79.1
ABSTRACT
BACKGROUND:
patients hospitalised with covid-19 suffer thrombotic complications. risk factors for poor outcomes are shared with coronary artery disease.Objectives:
to investigate efficacy of an acute coronary syndrome regimen in patients hospitalised with covid-19 and coronary disease risk factors. PATIENTS/METHODS:
a randomised controlled open-label trial across acute hospitals (uk and brazil) added aspirin, clopidogrel, low-dose rivaroxaban, atorvastatin, and omeprazole to standard care for 28-days. primary efficacy and safety outcomes were 30-day mortality and bleeding. the key secondary outcome was a daily clinical status (at home, in hospital, on intensive therapy unit admission, death).RESULTS:
320 patients from 9 centres were randomised. the trial terminated early due to low recruitment. at 30 days there was no significant difference in mortality (intervention 11.5% vs control 15%, unadjusted or 0.73, 95%ci 0.38 to 1.41, p=0.355). significant bleeds were infrequent and not significantly different between the arms (intervention 1.9% vs control 1.9%, p>0.999). using a bayesian markov longitudinal ordinal model, it was 93% probable that intervention arm participants were more likely to transition to a better clinical state each day (or 1.46, 95% cri 0.88 to 95 2.37, pr(beta>0) =93%; adjusted or 1.50, 95% cri 0.91 to 2.45, pr(beta>0) =95%) and median time to discharge home was two days shorter (95% cri -4 to 0, 2% probability that it was worse).CONCLUSIONS:
acute coronary syndrome treatment regimen was associated with a 99 reduction in the length of hospital stay without an excess in major bleeding. a larger trial is needed to evaluate mortality.
Full text:
Available
Collection:
National databases
/
Brazil
Health context:
Sustainable Health Agenda for the Americas
/
SDG3 - Health and Well-Being
/
SDG3 - Target 3.3 End transmission of communicable diseases
/
SDG3 - Target 3.4 Reduce premature mortality due to noncommunicable diseases
Health problem:
Goal 9: Noncommunicable diseases and mental health
/
Target 3.4: Reduce premature mortality due to noncommunicable diseases
/
COVID-19
/
Pneumonia
/
Cardiovascular Disease
/
Ischemic Heart Disease
/
Other Respiratory Diseases
Database:
CONASS
/
Sec. Est. Saúde SP
/
SESSP-IDPCPROD
Main subject:
Acute Coronary Syndrome
/
COVID-19
Type of study:
Controlled clinical trial
/
Prognostic study
/
Risk factors
Language:
English
Journal:
J. thromb. haemost
Year:
2023
Document type:
Article
Institution/Affiliation country:
BHF Centre for Cardiovascular Science, University of Edinburgh/GB
/
Blackpool Teaching Hospitals NHS Foundation Trust/GB
/
Brighton and Sussex Medical School, University of Sussex/GB
/
Chelsea & Westminster Foundation NHS Trust/GB
/
Heart and Lung Research Institute, Dept of Medicine, University of Cambridge/GB
/
Imperial Clinical Trials Unit, School of Public Health, Imperial College London/GB
/
Imperial College Healthcare NHS Trust/GB
/
Institute of Clinical Medicine, University of Oslo/NO
/
Instituto Dante Pazzanese de Cardiologia/BR
/
Instituto Prevent Senior/BR