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@article{Kanagaratnam:2023:10.1016/j.jtha.2023.04.045,
author = {Kanagaratnam, P and Francis, DP and Chamie, D and Coyle, C and Marynina, A and Katritsis, G and Paiva, P and Szigeti, M and Cole, G and de, Andrade Nunes D and Howard, J and Esper, R and Khan, M and More, R and Barreto, G and Meneguz-Moreno, R and Arnold, A and Nowbar, A and Kaura, A and Mariveles, M and March, K and Shah, J and Nijjer, S and Lip, GY and Mills, N and Camm, AJ and Cooke, GS and Corbett, SJ and Llewelyn, MJ and Ghanima, W and Toshner, M and Peters, N and Petraco, R and Al-Lamee, R and Boshoff, ASM and Durkina, M and Malik, I and Ruparelia, N and Cornelius, V and Shun-Shin, M},
doi = {10.1016/j.jtha.2023.04.045},
journal = {Journal of Thrombosis and Haemostasis},
pages = {2213--2222},
title = {A randomised controlled trial to investigate the use of acute coronary syndrome therapy in patients hospitalised with COVID-19: the C19-ACS trial},
url = {http://dx.doi.org/10.1016/j.jtha.2023.04.045},
volume = {21},
year = {2023}
}

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TY  - JOUR
AB  - 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 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 reduction in the length of hospital stay without an excess in major bleeding. A larger trial is needed to evaluate mortality.
AU  - Kanagaratnam,P
AU  - Francis,DP
AU  - Chamie,D
AU  - Coyle,C
AU  - Marynina,A
AU  - Katritsis,G
AU  - Paiva,P
AU  - Szigeti,M
AU  - Cole,G
AU  - de,Andrade Nunes D
AU  - Howard,J
AU  - Esper,R
AU  - Khan,M
AU  - More,R
AU  - Barreto,G
AU  - Meneguz-Moreno,R
AU  - Arnold,A
AU  - Nowbar,A
AU  - Kaura,A
AU  - Mariveles,M
AU  - March,K
AU  - Shah,J
AU  - Nijjer,S
AU  - Lip,GY
AU  - Mills,N
AU  - Camm,AJ
AU  - Cooke,GS
AU  - Corbett,SJ
AU  - Llewelyn,MJ
AU  - Ghanima,W
AU  - Toshner,M
AU  - Peters,N
AU  - Petraco,R
AU  - Al-Lamee,R
AU  - Boshoff,ASM
AU  - Durkina,M
AU  - Malik,I
AU  - Ruparelia,N
AU  - Cornelius,V
AU  - Shun-Shin,M
DO  - 10.1016/j.jtha.2023.04.045
EP  - 2222
PY  - 2023///
SN  - 1538-7836
SP  - 2213
TI  - A randomised controlled trial to investigate the use of acute coronary syndrome therapy in patients hospitalised with COVID-19: the C19-ACS trial
T2  - Journal of Thrombosis and Haemostasis
UR  - http://dx.doi.org/10.1016/j.jtha.2023.04.045
UR  - https://www.ncbi.nlm.nih.gov/pubmed/37230416
UR  - https://www.sciencedirect.com/science/article/pii/S1538783623004282
UR  - http://hdl.handle.net/10044/1/104619
VL  - 21
ER  -

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