Effect of antiplatelet therapy after COVID-19 diagnosis: A systematic review with meta-analysis and trial sequential analysis

by 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.

Based on the current debate on antiplatelet therapy in COVID-19 patients, we performed a systematic review and meta-analysis to investigate the effect of antiplatelet treatments. We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science on February 1, 2023, and only included Randomized clinical trials. The study followed PRISMA guidelines and used Random-effects models to estimate the pooled percentage and its 95% CI.

Five unique eligible studies were included, covering 17,950 patients with COVID-19. The result showed no statistically significant difference in the relative risk of all-cause death in antiplatelet therapy versus non-antiplatelet therapy (RR 0.94, 95% CI, 0.83–1.05, P = 0.26, I² = 32%). Compared to no antiplatelet therapy, patients who received antiplatelet therapy had a significantly increased relative risk of major bleeding (RR 1.81, 95%CI 1.09–3.00, P = 0.02, I² = 16%). The sequential analysis suggests that more RCTs are needed to draw more accurate conclusions. This systematic review and meta-analysis revealed that the use of antiplatelet agents exhibited no significant benefit on all-cause death, and the upper bound of the confidence interval on all-cause death (RR 95% CI, 0.83–1.05) suggested that it was unlikely to be a substantiated harm risk associated with this treatment. However, evidence from all RCTs suggested a high risk of major bleeding in antiplatelet agent treatments.

According to the results of our sequential analysis, there is not enough evidence available to support or negate the use of antiplatelet agents in COVID-19 cases. The results of ongoing and future well-designed, large, randomized clinical trials are needed.

Effect of local oxygen therapy combined with vacuum sealing drainage on the healing of stage IV sacrococcygeal pressure ulcers

Abstract

The present study aimed to investigate the effect of local oxygen therapy combined with vacuum sealing drainage (VSD) on the healing of stage IV pressure ulcers sacrococcygeal. In this prospective study, we included a total of 98 patients with stage IV sacrococcygeal pressure ulcers in our hospital between February 2021 and June 2022. The patients enrolled were randomly and equally divided into two groups: the study group (undergoing local oxygen therapy combined with VSD treatment) and the control group (receiving conventional treatment). The wound healing time and hospital stay were compared between the two groups. Additionally, the wound area, tissue type, wound exudation and pain intensity were assessed before treatment, 10, 20, 30 and 40 days after treatment. The incidence of complications was also calculated. The study group demonstrated significantly shorter wound healing time and hospital stays compared to the control group (p < 0.05). Before treatment, there were no significant differences in terms of wound area, tissue type and wound exudation between the two groups (p > 0.05); after 10, 20, 30 and 40 days of treatment, however, evidently smaller wound areas, improved tissue types and reduced wound exudation were observed in the study group compared to the control group (p < 0.05). Furthermore, the study group exhibited increased microvascular count compared to the control group (p < 0.05). Before treatment, there was no significant difference in pain intensity between the two groups (p > 0.05), whereas markedly lower pain intensity was seen in the study group than in the control group after 10, 20, 30 and 40 days of treatment (p < 0.05). The incidence of complications did not significantly differ between the two groups after 40 days of treatment (p > 0.05). Local oxygen therapy combined with VSD was found to effectively accelerate the healing process of stage IV sacrococcygeal pressure ulcers, leading to shorter hospital stays and improved patient prognosis. This combined therapy shows promise for widespread application in clinical practice.