Int J Infect Dis. 2026 Aug 29:109087. doi: 10.1016/j.ijid.2026.109087. Online ahead of print.
ABSTRACT
BACKGROUND: Dengue infection frequently causes thrombocytopenia and bleeding complications. Patients with cardiovascular disease who receive antiplatelet or anticoagulant therapy represent a clinically challenging population during acute dengue infection. Data regarding clinical outcomes and platelet recovery in these patients remain limited.
METHODS: This observational study included a single-center retrospective cardiovascular dengue cohort and an exploratory platelet-monitoring cohort. In the retrospective cohort, patients were classified according to pre-existing antithrombotic therapy (ATT) at dengue diagnosis: no antithrombotic therapy (No ATT), single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), or oral anticoagulant therapy (OAC). Major bleeding was assessed within 7 and 30 days after dengue diagnosis. In the exploratory platelet-monitoring cohort, serial platelet count and platelet function were assessed during dengue illness.
RESULTS: The retrospective cohort included 1,693 patients (No ATT, n = 1,493; SAPT, n = 163; DAPT, n = 22; OAC, n = 15). ATT users were older and had a greater burden of cardiovascular comorbidities and more frequent severe dengue manifestations. The observed 7-day major bleeding rates in the No ATT, SAPT, DAPT, and OAC groups were 0.34%, 0.61%, 4.55%, and 6.67%, respectively (P = 0.011), with corresponding 30-day rates of 1.15%, 1.84%, 9.09%, and 13.33% (P = 0.002). In the exploratory platelet-monitoring cohort (6 non-antiplatelet users and 2 aspirin users), aspirin users had a longer platelet count nadir-to-recovery time than non-antiplatelet users [median (IQR), 7.5 (6.0-9.0) vs 4.0 (3.75-4.25) days; P = 0.04] and a longer interval from the lowest platelet function value to recovery [median (IQR), 9.5 (8.0-11.0) vs 4.0 (3.75-4.25) days; P = 0.04].
CONCLUSIONS: Pre-existing ATT users had a greater comorbidity burden and more severe dengue manifestations. SAPT users showed similar observed short-term major bleeding rates to patients without ATT. Exploratory monitoring suggested delayed platelet count and function recovery among aspirin users.
PMID:42668060 | DOI:10.1016/j.ijid.2026.109087