Clinical outcomes and the impact of prior oral anticoagulant use in patients with coronavirus disease 2019 admitted to hospitals in the UK - a multicentre observational study.
Deepa R J ArachchillageIndika RajakarunaZain OdhoChristina Crossette-ThambiahPhillip L R NicolsonLara N RobertsCaroline AllanSarah LewisRenu RiatPhilip MounterCeri LynchAlexander LangridgeRoderick OakesNini AungAnja DrebesTina DuttPriyanka RahejaAlison DelaneySarah EssexGillian LoweDavid SuttonClaire LentaigneZara SayarMari KilnerTamara EveringtonSusan ShapiroRaza AlikhanRichard SzydloMichael P MakrisMichael A LaffanPublished in: British journal of haematology (2021)
Coagulation dysfunction and thrombosis are major complications in patients with coronavirus disease 2019 (COVID-19). Patients on oral anticoagulants (OAC) prior to diagnosis of COVID-19 may therefore have better outcomes. In this multicentre observational study of 5 883 patients (≥18 years) admitted to 26 UK hospitals between 1 April 2020 and 31 July 2020, overall mortality was 29·2%. Incidences of thrombosis, major bleeding (MB) and multiorgan failure (MOF) were 5·4%, 1·7% and 3·3% respectively. The presence of thrombosis, MB, or MOF was associated with a 1·8, 4·5 or 5·9-fold increased risk of dying, respectively. Of the 5 883 patients studied, 83·6% (n = 4 920) were not on OAC and 16·4% (n = 963) were taking OAC at the time of admission. There was no difference in mortality between patients on OAC vs no OAC prior to admission when compared in an adjusted multivariate analysis [hazard ratio (HR) 1·05, 95% confidence interval (CI) 0·93-1·19; P = 0·15] or in an adjusted propensity score analysis (HR 0·92 95% CI 0·58-1·450; P = 0·18). In multivariate and adjusted propensity score analyses, the only significant association of no anticoagulation prior to diagnosis of COVID-19 was admission to the Intensive-Care Unit (ICU) (HR 1·98, 95% CI 1·37-2·85). Thrombosis, MB, and MOF were associated with higher mortality. Our results indicate that patients may have benefit from prior OAC use, especially reduced admission to ICU, without any increase in bleeding.
Keyphrases
- coronavirus disease
- end stage renal disease
- atrial fibrillation
- ejection fraction
- chronic kidney disease
- sars cov
- emergency department
- peritoneal dialysis
- healthcare
- cross sectional
- randomized controlled trial
- prognostic factors
- intensive care unit
- cardiovascular events
- risk factors
- type diabetes
- venous thromboembolism
- oxidative stress
- metabolic syndrome
- respiratory syndrome coronavirus
- palliative care
- metal organic framework