6/28/23, 12:20 AM COVID-PACT (antiplatelet therapy) Pathway Feedback Search Clinical Topics Home Studies COVID PACT (antiplatelet therapy) COVID PACT (antiplatelet therapy) Disease COVID 19 infection Trial question What is the role of clopidogrel in critically ill patients with COVID-19? Study design Multi-center Open label RCT Population Characteristics of study participants 41.0% female N = 290 59.0% male 290 patients (118 female, 172 male) Inclusion criteria: adult patients with COVID-19 infection requiring ICU-level of care Key exclusion criteria: use of full-dose anticoagulation; use of dual antiplatelet therapy, contraindication to antithrombotic therapy; high risk of bleeding; heparin-induced thrombocytopenia; or ischemic stroke within the past 2 weeks Interventions N=150 clopidogrel (300 mg on the day of randomization, followed by 75 mg/day on subsequent days) N=140 no clopidogrel (no antiplatelet therapy) Primary outcome Rate of death due to venous and arterial thrombotic events through hospital discharge or 28 days 15 15.0 % https://web.pathway.md/studies/recg4rWFzkFahhMBP 1/2 6/28/23, 12:20 AM COVID-PACT (antiplatelet therapy) Pathway 11.3 11.3 % 7.5 % 3.8 % No significant difference 0.0 % Clopidogrel No clopidogrel No significant difference in the rate of death due to venous and arterial thrombotic events through hospital discharge or 28 days (11.3% vs. 15%; HR 0.9, 95% CI 0.48 to 1.69) Secondary outcomes No significant difference in death due to clinically evident venous and arterial thrombotic events (10.7% vs. 9.3%; HR 1.29, 95% CI 0.62 to 2.66) No significant difference in death from all causes (16% vs. 24.3%; HR 0.87, 95% CI 0.51 to 1.49) No significant difference in venous thrombotic events (17 events vs. 21 events; HR 0.9, 95% CI 0.48 to 1.69) Safety outcomes No significant differences in fatal and life-threatening bleeding, GUSTO moderate and severe bleeding. Conclusion In adult patients with COVID-19 infection requiring ICU-level of care, clopidogrel was not superior to no clopidogrel with respect to the rate of death due to venous and arterial thrombotic events through hospital discharge or 28 days. Reference Erin A Bohula, David D Berg, Mathew S Lopes et al. Anticoagulation and Antiplatelet Therapy for Prevention of Venous and Arterial Thrombotic Events in Critically Ill Patients with COVID-19: COVID-PACT. Circulation. 2022 Nov;146(18):1344-1356. Open reference URL https://web.pathway.md/studies/recg4rWFzkFahhMBP 2/2