REMAP-CAP (antiplatelets)
Trial question
What is the role of antiplatelet therapy in critically ill patients with COVID-19?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
34.0% female
66.0% male
N = 1549
1549 patients (521 female, 1028 male)
Inclusion criteria: critically ill adult patients with COVID-19
Key exclusion criteria: imminent death; bleeding risk contraindicating antiplatelet therapy; CrCl < 30 mL/min; receipt of RRT; enrollment in an external trial
Interventions
N=1020 antiplatelet therapy (aspirin or P2Y12 inhibitor)
N=529 no antiplatelet therapy (no antiplatelet agent or NSAID)
Primary outcome
Organ support-free days at 21 days
7
7
7.0 days
5.3 days
3.5 days
1.8 days
0.0 days
Antiplatelet
therapy
No antiplatelet
therapy
No significant
difference ↔
No significant difference in organ support-free days at 21 days (7 days vs. 7 days; aOR 1.02, 95% CI 0.86 to 1.23)
Secondary outcomes
No significant difference in survival to hospital discharge (71.5% vs. 67.9%; aOR 1.27, 95% CI 0.99 to 1.62)
Borderline significant decrease in thrombotic events or death (35.1% vs. 40.7%; aOR 0.7, 95% CI 0.54 to 0.9)
Borderline significant increase in major bleeding (2.1% vs. 0.4%; aOR 2.97, 95% CI 1.23 to 8.28)
Safety outcomes
No significant difference in serious adverse events.
Conclusion
In critically ill adult patients with COVID-19, antiplatelet therapy was not superior to no antiplatelet therapy with respect to organ support-free days at 21 days.
Reference
REMAP-CAP Writing Committee for the REMAP-CAP Investigators, Charlotte A Bradbury, Patrick R Lawler et al. Effect of Antiplatelet Therapy on Survival and Organ Support-Free Days in Critically Ill Patients With COVID-19: A Randomized Clinical Trial. JAMA. 2022 Apr 5;327(13):1247-1259.
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