Chronic Oral Anticoagulation and Clinical Outcome in Hospitalized COVID-19 Patients

• Published in: Cardiovascular drugs and therapy Vol. 36; no. 4; pp. 705 - 712
• Main Authors: Russo, Vincenzo, Bottino, Roberta, D’Andrea, Antonello, Silverio, Angelo, Di Maio, Marco, Golino, Paolo, Nigro, Gerardo, Valsecchi, Orazio, Attena, Emilio, Canonico, Mario Enrico, Galasso, Gennaro, Parodi, Guido, Scudiero, Fernando
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-08-2022; Springer Nature B.V
• Subjects: Antagonists; Anticoagulants; Cardiology; Cardiovascular disease; Clinical outcomes; Coronary artery; Coronary artery disease; Coronaviruses; COVID-19; Diabetes mellitus; Heart diseases; Heparin; Hospitalization; Hypertension; Medicine; Medicine & Public Health; Mortality; Original; Original Article; Patients; Respiratory distress syndrome; Risk; Thromboembolism; Vitamin K; COVID-19; NOACs; SARS-CoV-2; VKA; Outcome; ARDS
• ISSN: 0920-3206; 1573-7241
• DOI: 10.1007/s10557-021-07194-y

Purpose
The clinical course of COVID-19 may be complicated by acute respiratory distress syndrome (ARDS) and thromboembolic events, which are associated with high risk of mortality. Although previous studies reported a lower rate of death in patients treated with heparin, the potential benefit of chronic oral anticoagulation therapy (OAT) remains unknown. We aimed to investigate the association between OAT with the risk of ARDS and mortality in hospitalized patients with COVID-19.
Methods
This is a multicenter retrospective Italian study including consecutive patients hospitalized for COVID-19 from March 1 to April 22, 2020, at six Italian hospitals. Patients were divided into two groups according to the chronic assumption of oral anticoagulants.
Results
Overall, 427 patients were included; 87 patients (19%) were in the OAT group. Of them, 54 patients (13%) were on treatment with non-vitamin k oral anticoagulants (NOACs) and 33 (8%) with vitamin-K antagonists (VKAs). OAT patients were older and had a higher rate of hypertension, diabetes, and coronary artery disease compared to No-OAT group. The rate of ARDS at admission (26% vs 28%,
P
=0.834), or developed during the hospitalization (9% vs 10%,
P
=0.915), was similar between study groups; in-hospital mortality (22% vs 26%,
P
=0.395) was also comparable. After balancing for potential confounders by using the propensity score matching technique, no differences were found in term of clinical outcome between OAT and No-OAT patients
Conclusion
Oral anticoagulation therapy, either NOACs or VKAs, did not influence the risk of ARDS or death in patients hospitalized with COVID-19.