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

Abstract

Summary 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.

Anticoagulant treatment and COVID‐19 mortality among older adults living in nursing homes in Sweden

“…25,28,38 5 | CONCLUSIONSIn this matched cohort study of unvaccinated NH residents with diagnosed COVID-19, we found that incident use of LMWH and prevalent use of DOAC was significantly associated with reduced mortality in multivariable analyses adjusted for age, sex, multimorbidity, and immobility. The association between prophylactic use of LMWH and reduced mortality was most evident among female patients.…”

“…26 One cohort study investigated initiation of AC treatment, including incident DOAC, while excluding prevalent AC in 3625 individuals (39% were older than events in propensity score-matched analyses. 28 A retrospective analysis of 1612 individuals with a mean age of 67 years consecutively admitted to hospital with COVID-19 during the early phase of the pandemic (spring of 2020) failed to show any impact on mortality with either oral or parenteral AC. 29 Finally, a large registerbased study did not find any evidence to support that prevalent use of DOAC decreases the risk for severe COVID-19 infection or mortality rate.…”

Arterial Thrombotic Events in Hospitalized COVID-19 Patients: A Short Review and Meta-Analysis

“…A total of 36 articles were included in the pooled analysis ( Table 1 ). 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 The majority (28; 78%) consisted of retrospective cohort studies whereas three (8%) were RCTs and five (14%) were prospective cohort studies ( Table 1 ).…”

HaemSTAR—Growing Experience From a National, Trainee-led Research Network

“…The study recruited over 5000 patients and has resulted in 2 publications. 11 , 12 The PI described “the study as successful because of the great support from HaemSTAR.” In 2021, HaemSTAR collected vital patient-level data for PHE to ascertain the incidence of vaccine-induced immune-mediated thrombotic thrombocytopenia confirming diagnostic criteria and incidence at a national level (submitted for publication).…”