Anticoagulation Before Hospitalization Is a Potential Protective Factor for COVID‐19: Insight From a French Multicenter Cohort Study

Chocron, Richard; Galand, Vincent; Cellier, Joffrey; Gendron, Nicolas; Pommier, Thibaut; Bory, Olivier; Khider, Lina; Trimaille, Antonin; Goudot, Guillaume; Weizman, Orianne; Alsac, Jean Marc; Geneste, Laura; Schmeltz, Armand; Panagides, Vassili; Philippe, Aurélien; Marsou, Wassima; Abdallah, Iannis Ben; Deney, Antoine; Batti, Salma El; Attou, Sabir; Juvin, Philippe; Delmotte, Thomas; Messas, Emmanuel; Pezel, Théo; Planquette, Benjamin; Duceau, Baptiste; Gaussem, Pascale; Sutter, Willy; Sanchez, Olivier; Waldmann, Victor; Diehl, Jean‐Luc; Mirault, Tristan; Bonnet, Guillaume; Cohen, Ariel; Smadja, David M.

doi:10.1161/jaha.120.018624

Cited by 51 publications

(66 citation statements)

References 35 publications

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“…Other studies have also evaluated patients diagnosed with COVID-19 to determine complication and mortality rates in patients with previous antithrombotic therapy [ 23 , 26 , 30 , 33 , 34 ]. Those studies included from 110 to 731 anticoagulated patients and from 98 to 912 patients on antiplatelet therapy, with highly heterogenous findings.…”

Section: Discussionmentioning

confidence: 99%

“…For example, in a nationwide registry-based study, Fröhlich et al found that hospitalized patients who received DOACs or VKA had better composite (all-cause mortality or need for non-invasive or invasive ventilation or extracorporeal membrane oxygenation) outcomes compared to those on antiplatelet therapy [ 33 ]. Chocron and colleagues found that AC therapy prior to hospitalization was associated with better clinical outcomes (ICU admission and/or in-hospital mortality) [ 34 ]. By contrast, Tremblay et al observed no improvement in all-cause mortality, time-to-mechanical ventilation, or need for hospitalization in either group (AC or AP) [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…This hypothesis, if true, suggests that patients receiving chronic anticoagulation (AC) or antiplatelet therapy (AP) may be at least partially protected from COVID-19-related thromboembolic complications and should theoretically be expected to have better clinical outcomes than patients not on antithrombotic therapy prior to admission. However, the available evidence from observational studies is contradictory, and thus the role of antithrombotic therapy in these patients remains unclear [ 22 – 34 ].…”

Section: Introductionmentioning

confidence: 99%

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Impact of pre-admission antithrombotic therapy on disease severity and mortality in patients hospitalized for COVID-19

Corrochano

Acosta-Isaac

Mojal

et al. 2021

J Thromb Thrombolysis

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Anticoagulant therapy is a cornerstone treatment for coronavirus disease 2019 (COVID-19) due to the high rates of thromboembolic complications associated with this disease. We hypothesized that chronic antithrombotic therapy could play a protective role in patients hospitalized for COVID-19. Retrospective, observational study of all patients admitted to our hospital for ≥ 24 h from March 1 to May 31, 2020 with SARS-CoV-2. The objective was to evaluate clinical outcomes and mortality in COVID-19 patients receiving chronic anticoagulation (AC) or antiplatelet therapy (AP) prior to hospital admission. A total of 1612 patients were evaluated. The mean (standard deviation; SD) age was 66.5 (17.1) years. Patients were divided into three groups according to the use of antithrombotic therapy prior to admission (AP, AC, or no-antithrombotic treatment). At admission, 9.6% of the patients were taking anticoagulants and 19.1% antiplatelet therapy. The overall mortality rate was 19.3%. On the multivariate analysis there were no significant differences in mortality between the antithrombotic groups (AC or AP) and the no-antithrombotic group (control group). Patients on AC had lower ICU admission rates than the control group (OR: 0.41, 95% CI, 0.18–0.93). Anticoagulation therapy prior to hospitalization for COVID-19 was associated with lower ICU admission rates. However, there were no significant differences in mortality between the patients receiving chronic antithrombotic therapy and patients not taking antithrombotic medications. These findings suggest that chronic anticoagulation therapy at the time of COVID-19 infection may reduce disease severity and thus the need for ICU admission.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of pre-admission antithrombotic therapy on disease severity and mortality in patients hospitalized for COVID-19

Corrochano

Acosta-Isaac

Mojal

et al. 2021

J Thromb Thrombolysis

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“…Interestingly, no benefit was observed for therapeutic or prophylactic treatment started in hospital. 28 COVID-19 patients show frequent alterations of the coagulation system characterized by higher levels of D-dimer, reduced platelet count, and prolonged prothrombin time. More relevant changes seem to characterize subjects with a worse prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…correlated to a reduced risk of intensive care unit admission and/or death. Interestingly, no benefit was observed for therapeutic or prophylactic treatment started in hospital [28].…”

Section: Accepted Manuscriptmentioning

confidence: 97%

COVID-19 and Atrial Fibrillation in Older Patients: Does Oral Anticoagulant Therapy Provide a Survival Benefit?—An Insight from the GeroCovid Registry

Fumagalli

Trevisan

Signore³

et al. 2021

Thromb Haemost

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Introduction. Atrial fibrillation (AF), the most frequent arrhythmia of older patients, associates with serious thrombo-embolic complications and high mortality. COVID-19 severely affects aged subjects, determining an important prothrombotic status. Aim of this study was to evaluate mortality-related factors in older AF patients with COVID-19. Methods. Between March and June 2020, we enrolled >=60 years in-hospital COVID-19 patients (N=806) in GeroCovid, a multicenter observational study promoted by the Italian Society of Gerontology and Geriatric Medicine. Results. The prevalence of AF was 21.8%. In-hospital mortality was higher in the AF group (36.9 vs. 27.5%, p=0.015). At admission, 51.7%, 10.2% and 38.1% of AF cases were taking, respectively, oral anticoagulants (OACs), antiplatelet agents and no antithrombotic therapy. During hospitalization, 51% patients switched to low-molecular weight heparins. AF patients who survived were younger (81±8 vs. 84±7 years; p=0.002) and had a lower CHA2DS2-VASc score (3.9±1.6 vs. 4.4±1.3; p=0.02) than those who died. OACs use before (63.1% vs. 32.3%; p<0.001) and during hospitalization (34.0% vs. 12.7%; p=0.002) was higher among survivors. At multivariable analysis, lower age, higher self-sufficiency, less severe initial COVID-19 presentation, and the use of Vitamin K antagonists (OR=0.16, 95%CI: 0.03-0.84) or DOACs (OR=0.22, 95%CI: 0.08-0.56) at admission, or the persistence of OAC during hospitalization (OR=0.05, 95%CI: 0.01-0.24), were associated with a lower chance of in-hospital death. Conclusions. AF is a prevalent and severe condition in older COVID-19 patients. Advanced age, dependency and relevant clinical manifestations of disease characterized a worse prognosis. Pre-admission and in-hospital anticoagulant therapy were positively associated with survival.

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Association between pre‐admission anticoagulation and in‐hospital death, venous thromboembolism, and major bleeding among hospitalized COVID‐19 patients in Japan

Adomi

Kuno

Komiyama

et al. 2022

Pharmacoepidemiology and Drug

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Purpose: The coagulation activation leads to thrombotic complications such as venous thromboembolism (VTE) in patients with coronavirus disease-2019 . Prophylactic anticoagulation therapy has been recommended for hospitalized COVID-19 patients in clinical guidelines. This retrospective cohort study aimed to examine the association between pre-admission anticoagulation treatment and three outcomes: in-hospital death, VTE, and major bleeding among hospitalized COVID-19 patients in Japan.Methods: Using a large-scale claims database built by the Medical Data Vision Co. in Japan, we identified patients hospitalized for COVID-19 who had outpatient prescription data at least once within 3 months before being hospitalized. Exposure was set as pre-admission anticoagulation treatment (direct oral anticoagulant or vitamin K antagonist), and outcomes were in-hospital death, VTE, and major bleeding. We conducted multivariable logistic regression analyses, adjusting for a single summarized score (a propensity score of receiving pre-admission anticoagulation) for VTE and major bleeding, due to the small number of outcomes.Results: Among the 2612 analytic patients, 179 (6.9%) had pre-admission anticoagulation. Crude incidence proportions were 13.4% versus 8.5% for in-hospital

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Anticoagulation Before Hospitalization Is a Potential Protective Factor for COVID‐19: Insight From a French Multicenter Cohort Study

Cited by 51 publications

References 35 publications

Impact of pre-admission antithrombotic therapy on disease severity and mortality in patients hospitalized for COVID-19

Impact of pre-admission antithrombotic therapy on disease severity and mortality in patients hospitalized for COVID-19

COVID-19 and Atrial Fibrillation in Older Patients: Does Oral Anticoagulant Therapy Provide a Survival Benefit?—An Insight from the GeroCovid Registry

Association between pre‐admission anticoagulation and in‐hospital death, venous thromboembolism, and major bleeding among hospitalized COVID‐19 patients in Japan

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