Abstract 14457: Safety and Effectiveness of P2Y12 Inhibitors in Critically Ill Patients With COVID-19: A Meta-Analysis of Randomized Controlled Trials

Introduction: Critically ill patients with COVID-19 have a high risk of developing thromboembolic events. Randomized controlled trials (RCTs) have shown conflicting results regarding the use of P2Y12 inhibitors in such patients. We conducted a meta-analysis of the available trials.

Methods: Studies comparing P2Y12 inhibitors vs control in critically ill patients with COVID-19 were searched from online databases. The primary endpoints of interest were myocardial infarction (MI), systemic arterial thromboembolism, deep venous thrombosis (DVT), pulmonary embolism (PE), ischemic stroke, mortality, and major bleeding at the longest available follow up. Random-effects model was used to calculate risk ratios (RR) with 95% confidence intervals (CI).

Results: Three RCTs, with a total of 2,223 patients - 1,084 in the P2Y12 inhibitor group and 1,139 in the control group were included. The mean age was 57 years and 63% of patients were men. The follow up duration varied from 28 to 90 days. The two groups had similar risk of DVT (RR 0.91, 95% CI 0.65-1.28, p = 0.60), ischemic stroke (RR 2.25, 95% CI 0.91-5.55, p = 0.08), MI (RR 1.37, 95% CI 0.54-3.47, p = 0.50), PE (RR 0.95, 95% CI 0.47-1.95, p = 0.90), systemic arterial thromboembolism (RR 1.20, 95% CI 0.24-6.09, p = 0.82), mortality (RR 0.89, 95% CI 0.77-1.03, p = 0.12) (Figure 1) and major bleeding (RR 1.34, 95% CI 0.47-3.78, p = 0.59) (Figure 2).

Conclusions: No significant difference was found in venous or arterial thromboembolism, mortality, or major bleeding events in critically ill COVID-19 patients treated with P2Y12 inhibitors as compared to control.