Пациенты с лихорадкой денге на антикоагулянтах и двойной антиагрегантной терапии имеют повышенный риск кровотечений

TOPLINE Patients with acute dengue infection who were on dual antiplatelet therapy (DAPT) or oral anticoagulant therapy (OAC) had higher rates of major bleeding within 7 days of diagnosis than those not receiving antithrombotic therapy (ATT), whereas those on single antiplatelet therapy (SAPT) showed major bleeding rates similar to those not receiving ATT at both 7 and 30 days after diagnosis. METHODOLOGY - Researchers conducted a single-center, observational study to evaluate real-world bleeding and cardiovascular outcomes in patients with acute dengue infection receiving pre-existing ATT. - The study comprised a retrospective cardiovascular cohort that used data from a hospital database to identify patients who developed dengue infection between 2015 and 2022 and an exploratory platelet-monitoring cohort that tracked platelet count and platelet function during dengue illness. - Patients in the retrospective cohort were classified into four groups based on pre-existing ATT at dengue diagnosis: no ATT (n = 1493; mean age, 63.2 years; 50.5% men), SAPT (n = 163; mean age, 71.7 years; 67.5% men), DAPT (n = 22; mean age, 70.1 years; 63.6% men), and OAC (n = 15; mean age, 70.3 years; 73.3% men). - The exploratory cohort included patients not receiving antiplatelet therapy (n = 6) and those receiving aspirin (n = 2) who underwent serial platelet count and platelet function assessments during dengue illness to evaluate platelet recovery patterns. - Outcomes were major bleeding events and major adverse cardiovascular events assessed within 7 and 30 days after dengue diagnosis. TAKEAWAY - Patients receiving pre-existing ATT were significantly older and experienced more frequent severe dengue manifestations, including severe plasma leakage and severe organ involvement, than those not receiving ATT (P < .001). - Within 7 days of dengue diagnosis, major bleeding rates were 0.34% in the no ATT group, 0.61% in the SAPT group, 4.55% in the DAPT group, and 6.67% in the OAC group (P = .011); major adverse cardiovascular events occurred in 1 patient in the no ATT group and 3 patients in the DAPT group, with no events in the SAPT or OAC groups. - Within 30 days of dengue diagnosis, major bleeding rates were 1.15% in the no ATT group, 1.84% in the SAPT group, 9.09% in the DAPT group, and 13.33% in the OAC group (P = .002); major adverse cardiovascular events occurred in 7 patients in the no ATT group, 2 patients in the SAPT group, and 3 patients in the DAPT group, with no events in the OAC group. - In the exploratory cohort, recovery of platelet counts and platelet function was slower among patients receiving aspirin than among those not receiving antiplatelet therapy during dengue illness, with median recovery times of 7.5 vs 4.0 days and 9.5 vs 4.0 days, respectively (P = .04 for both). IN PRACTICE "These findings suggest that patients receiving pre-existing ATT, including those receiving SAPT, appeared to represent a clinically vulnerable group in this cohort," the authors wrote. SOURCE The study was led by Po-Tseng Lee, National Cheng Kung University Hospital, Tainan, Taiwan. It was published online on August 29 in International Journal of Infectious Diseases. LIMITATIONS The single-center observational design and nonrandomized treatment allocation resulted in baseline differences in risk across ATT groups. Major bleeding and cardiovascular events were sparse, particularly in the DAPT and OAC groups, which limited the precision and reliability of the estimated risks. Classification of ATT at dengue diagnosis may have led to exposure misclassification because information on treatment adherence, last dose, treatment interruption, resumption timing, platelet thresholds, and anticoagulant intensity was not systematically available. DISCLOSURES The study was supported by a research grant from the National Health Research Institutes and the Ministry of Science and Technology, Taiwan, Republic of China. The authors declared having no known competing financial interests or personal relationships that could have influenced the reported work. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.