Publication date: Feb 10, 2025

Coronavirus disease 2019 (COVID-19) is a systemic infection frequently involving the haematopoietic system. Thrombocytopenia is associated with increased risks of severe disease progression and mortality. Antiviral agents have shown much promise in decreasing viral load and shortening the time to the resolution of symptoms. However, their effect on platelet counts in patients with COVID-19 remains unexplored. Therefore, we first performed a retrospective study to evaluate the variation in platelet mass of hospitalized patients with high-risk COVID-19 who were given either SARS-CoV-2 main protease inhibitor, nucleoside reverse transcriptase inhibitor or no antiviral agents. A total of 177 patients were included, among which 64 received azvudine, 12 received nirmatrelvir-ritonavir and 101 patients received none. Compared to those without antiviral treatment, significantly higher platelet counts’ increments were observed in patients receiving azvudine or nirmatrelvir-ritonavir (p = 0. 001). Of note, this elevation was significantly more profound in the azvudine group than that in the control group (p 

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