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Effect of Antiplatelet Therapy After COVID-19 Diagnosis: A Systematic Review with Meta-analysis and Trial Sequential Analysis

Hong Duo, Mengying Jin, Yanwei Yang, Rewaan Baheti, Yujia Feng, Zirui Fu, Yuyue Jiang, Lanzhuoying Zheng, Jing Wan, Huaqin Pan.


Coronavirus disease 2019 (COVID-19) may predispose patients to thrombotic disease in the venous and arterial circulations.


Coronavirus disease 2019 (COVID-19) represents an unprecedented global threat caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 may predispose patients to thrombotic disease in both venous and arterial circulations, due to excessive inflammation, platelet activation, endothelial dysfunction, and stasis. Critically ill COVID-19 patients are at an elevated risk of hypercoagulability and increased thrombotic risk. Interactions between activated platelets and neutrophils lead to the breakdown of extracellular matrix proteins and the production of thrombin, which may be associated with disseminated intravascular coagulation (DIC) and a hypercoagulable state.


There were no restrictions on sample size or geographical location for included studies. Instead, restrictions on the language used in paper (only English), COVID-19 patients’ ages (>18 years) were set, and the inclusion of patients diagnosed with COVID-19. Studies were included if they compared antiplatelet therapy to no antiplatelet therapy and provided available data on at least one of our primary outcomes (all-cause death).


This systematic review and meta-analysis comprehensively assess the available evidence of randomized clinical trials (RCTs) regarding the effect of antiplatelet agents in COVID-19 patients. We originally included data from 5 randomized clinical trials, but only 4 provided available data to meet our quantitative evaluation, all of which were judged to be at low risk to some concern of bias. Only nine percent of participants completed the ACTIV-4B trial of aspirin in clinically stable outpatients with COVID-19 symptoms after enrollment because of the fewer adverse outcomes events than expected.

Citation: Duo H, Jin M, Yang Y, Baheti R, Feng Y, Fu Z, et al. (2024) Effect of antiplatelet therapy after COVID-19 diagnosis: A systematic review with meta-analysis and trial sequential analysis. PLoS ONE 19(2): e0297628.

Editor: Mohamed Saad, Hamad Medical Corporation, QATAR

Received: March 25, 2023; Accepted: January 9, 2024; Published: February 1, 2024.

Copyright: © 2024 Duo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its supporting information files.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.


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