Anticoagulation Prior to COVID-19 Infection Has No Impact on 6 Months Mortality: A Propensity Score–Matched Cohort Study

Abstract

The coronavirus disease 2019 (COVID-19) shows high incidence of thromboembolic events in humans. In the present study, we aimed to evaluate if anticoagulation prior to COVID-19 infection may impact clinical profile, as well as mortality rate among patients hospitalized with COVID-19. The study was based on retrospective analysis of medical records of patients with laboratory confirmed SARS-CoV-2 infection. After propensity score matching (PSM), a group of 236 patients receiving any anticoagulant treatment prior to COVID-19 infection (AT group) was compared to 236 patients without previous anticoagulation (no AT group). In 180 days, the observation we noted comparable mortality rate in AT and no AT groups (38.5% vs. 41.1%, p = 0.51). Similarly, we did not observe any statistically significant differences in admission in the intensive care unit (14.1% vs. 9.6%, p = 0.20), intubation and mechanical ventilation (15.0% vs. 11.6%, p = 0.38), catecholamines usage (14.3% vs. 13.8%, p = 0.86), and bleeding rate (6.3% vs. 8.9%, p = 0.37) in both groups. Our results suggest that antithrombotic treatment prior to COVID-19 infection is unlikely to be protective for morbidity and mortality in patients hospitalized with COVID-19.

Sex-Dependent Differences in Predictive Value of the C2HEST Score in Subjects with COVID-19—A Secondary Analysis of the COLOS Study

“…Initial higher level of INR in males high-risk C 2 HEST score stratum seems to support this thesis. Although the principal clinical manifestation of severe COVID-19 is a respiratory failure with a coexisting uncontrolled immune reaction, subjects with COVID-19 show a high incidence of thromboembolic events [ 29 ], particularly in fatal cases [ 30 ], however antithrombotic treatment prior to COVID-19 infection is unlikely to have a protective effect [ 31 ]. Bleeding complications in subjects with COVID-19 give rise to justifiable concerns [ 32 , 33 ] and should always be considered before applying anticoagulation in patients with SARS-CoV-2 infection.…”

Covid-19 and comedications in atrial fibrillation – a case-control study in Stockholm

“…The authors report that crude hospital mortality rate was higher for medicated patients, but not so after multivariable adjustments. Similarly, an observational study from Poland demonstrated that pre-COVID-19-anticoagulation had no impact on middle-term mortality [25]. A nationwide pharmacoepidemiologic study from Sweden [13] assessed impact of antithrombotic medication on hospitalization and a composite outcome of ICU admission and death from February to May 2020.…”

Good practice statements for antithrombotic therapy in the management of COVID‐19: Guidance from the SSC of the ISTH

“…13 Yet, observational studies have produced conflicting data on whether baseline use of oral anticoagulants including VKAs improves or worsens clinical outcomes among patients hospitalized with COVID-19 pneumonia. [65][66][67] Existing guidance does not compare oral anticoagulant therapies for COVID-19 inpatients and there is a lack of high-quality studies specifically on continuation of pre-hospital VKAs during admission. 59,68 A major question in the anticoagulation of patients hospitalized for COVID-19 pneumonia is whether to continue DOACs in those patients with pre-existing indications.…”

“…Patients prescribed VKA therapy who develop COVID‐19 pneumonia exhibit a decreased time in therapeutic range and increased variance of INR measurements 13 . Yet, observational studies have produced conflicting data on whether baseline use of oral anticoagulants including VKAs improves or worsens clinical outcomes among patients hospitalized with COVID‐19 pneumonia 65–67 . Existing guidance does not compare oral anticoagulant therapies for COVID‐19 inpatients and there is a lack of high‐quality studies specifically on continuation of pre‐hospital VKAs during admission 59,68 …”