Pharmacotherapy of atrial fibrillation in COVID-19 patients

• Published in: Cardiology journal Vol. 28; no. 5; pp. 758 - 766
• Main Authors: Tomaszuk-Kazberuk, Anna, Koziński, Marek, Domienik-Karłowicz, Justyna, Jaguszewski, Miłosz, Darocha, Szymon, Wybraniec, Maciej, Dobrowolski, Piotr, Kupczyńska, Karolina, Michalski, Błażej, Wańha, Wojciech, Kapłon-Cieślicka, Agnieszka
• Format: Journal Article
• Language: English
• Published: Poland Wydawnictwo Via Medica 2021; Via Medica
• Subjects: Administration, Oral; Aged; Anticoagulants; Anticoagulants - adverse effects; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Atrial Fibrillation - drug therapy; Cardiac arrhythmia; Coronaviruses; COVID-19; COVID-19 Vaccines; Drug therapy; Heparin; Heparin, Low-Molecular-Weight - therapeutic use; Humans; Pandemics; SARS-CoV-2; Stroke; Vitamin K; atrial fibrillation; infection; severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2); coronavirus disease 2019 (COVID-19); coronavirus; non-vitamin K antagonist oral anticoagulants (NOACs); direct oral anticoagulants (DOACs)
• ISSN: 1897-5593; 1898-018X
• DOI: 10.5603/CJ.a2021.0088

The coronavirus pandemic disease 2019 (COVID-19) has changed the face of contemporary medicine. However, each and every medical practitioner must be aware of potential early and late complications of COVID-19, its impact on chronic diseases - especially ones as common as atrial fibrillation (AF) - and the possible interactions between patients' chronic medications and pharmacotherapy of COVID-19. Patients with AF due to comorbidities and, often, elderly age are assumed to be at a higher risk of a severe course of COVID-19. This expert consensus summarizes the current knowledge regarding the pharmacotherapy of AF patients in the setting of the COVID-19 pandemic. In general, anticoagulation principles in quarantined or asymptomatic individuals remain unchanged. Nevertheless, it is advisable to switch from vitamin K antagonists to non-vitamin K antagonist oral anticoagulants (NOACs) whenever possible due to their consistent benefits and safety with fixed dosing and no monitoring. Additionally, in AF patients hospitalized due to mild or moderate COVID-19 pneumonia, we recommend continuing NOAC treatment or to switching to low-molecular-weight heparin (LMWH). On the other hand, in severely ill patients hospitalized in intensive care units, intravenous or subcutaneous dosing is preferable to oral, which is why the treatment of choice is either LMWH or unfractionated heparin. Finally, particularly in critical scenarios, the treatment strategy in COVID-19 patients with AF should be individualized based on possible interactions between anticoagulants, antiarrhythmics, antivirals, and antibiotics. In this consensus, we also discuss how to safely perform COVID-19 vaccination in anticoagulated AF patients.