Antiviral therapy and interleukin-6 blockade associated with lower thrombotic risk in hospitalized COVID-19: a target trial emulation.

Authors

Sergio Padilla, María Andreo, Christian Ledesma, Marta Fernández-González, Guillermo Telenti, José López-Escudero, Melissa Bello-Pérez, Paula Mascarell, Ángela Botella, Javier García-Abellán, María Espinosa, Mar Masiá, Félix Gutiérrez

Published in

Scientific reports. Jul 05, 2026. Epub Jul 05, 2026.

Abstract

Thrombotic complications substantially contribute to morbidity and mortality in hospitalized patients with COVID-19, but the effect of antiviral and immune-targeted therapies on thrombotic risk remains uncertain. We conducted an observational cohort study embedded in a prospectively implemented hospital COVID-19 care protocol, including 2,524 patients hospitalized with PCR-confirmed COVID-19 between March 2020 and July 2022, with systematic ascertainment of thrombotic events within 28 days after admission under standardized thromboprophylaxis. Treatment effects of remdesivir, tocilizumab, and glucocorticoids were evaluated in a nested propensity score-matched cohort using time-varying Cox models and target trial emulation estimating intention-to-treat and per-protocol effects. In time-varying Cox models, tocilizumab and remdesivir were associated with lower thrombotic risk (average HR 0.40, 95% CI 0.25-0.65, and 0.44, 95% CI 0.24-0.78, respectively), whereas glucocorticoids showed no protective association. These effects were driven by a marked early benefit on day 3, with HRs of 0.23 (95% CI 0.12-0.42) for tocilizumab and 0.23 (95% CI 0.11-0.51) for remdesivir, which progressively attenuated over follow-up. In the target trial emulation, intention-to-treat analyses also showed lower thrombotic risk with tocilizumab (OR 0.39; 95% CI 0.17-0.87) and remdesivir (OR 0.44; 95% CI 0.21-0.93), with directionally consistent per-protocol estimates. These findings suggest a thrombotic benefit of antiviral therapy and interleukin-6 blockade beyond standard anticoagulation in selected high-risk patients.

PMID:
42402635
Bibliographic data and abstract were imported from PubMed on 06 Jul 2026.

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