Effect on Morbidity and Mortality of Direct Oral Anticoagulants in Patients With COVID-19

Toubasi, Ahmad A.

doi:10.1016/j.amjcard.2022.02.007

Cited by 10 publications

(7 citation statements)

References 11 publications

(13 reference statements)

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“…In the study, it has been found in the multivariable analysis that the use of direct oral anticoagulants (DOACs) in patients with COVID-19 and atrial fibrillation was associated with significantly reduced risk of mortality (odds ratio = 0.597; 95% confidence interval 0.402–0.888). The findings of this study resonate with the findings of a meta-analysis 2 which determined the effects of the use of DOACs on morbidity and mortality in patients with COVID-19, and reported that the use of DOACs was significantly associated with a reduced risk of severe or fatal COVID-19 (odds ratio = 0.50; 95% confidence interval 0.33–0.76).…”

supporting

confidence: 82%

Direct oral anticoagulants (DOAC) for patients with atrial fibrillation during the COVID-19 pandemic

Kow

Ramachandram²,

Hasan³

2022

Medicina Clínica (English Edition)

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supporting

confidence: 82%

Direct oral anticoagulants (DOAC) for patients with atrial fibrillation during the COVID-19 pandemic

Kow

Ramachandram²,

Hasan³

2022

Medicina Clínica (English Edition)

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“…Toubasi's findings 45 suggested that previous use of DOACs reduced the mortality and severity among patients with COVID-19. It also substantiated the benefits of DOAC use in improving the outcomes of several diseases.…”

Section: Discussionmentioning

confidence: 98%

“…Consequently, they need to be evaluated for efficacy and safety in COVID-19 patients compared with the standard prophylactic treatment of heparin. Toubasi's findings 45 suggested that previous use of DOACs reduced the mortality and severity among patients with COVID-19. It also substantiated the benefits of DOAC use in improving the outcomes of several diseases.…”

Section: Discussionmentioning

confidence: 98%

Efficacy and Safety of Direct Oral Anticoagulants Compared With Heparin for Preventing Thromboembolism in Hospitalized Patients With COVID-19: A Systematic Review and Meta-Analysis

Tian

Pan

Wen

et al. 2023

Clin Appl Thromb Hemost

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A high rate of thromboembolism and a high risk of death have been reported regarding hospitalized patients with coronavirus disease 2019 (COVID-19). Recently, we noticed that clinicians in some comparative studies used direct oral anticoagulants (DOACs) to prevent thromboembolism in patients with COVID-19. However, it is uncertain whether DOACs are better than recommended heparin for hospitalized patients with COVID-19. Therefore, a direct comparison of the prophylactic effects and safety between DOACs and heparin is needed. We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library from 2019 to December 1, 2022. Randomized controlled trials or retrospective studies comparing the efficacy or safety of DOACs with that of heparin in preventing thromboembolism for hospitalized patients with COVID-19 were included. We assessed endpoints and publication bias using Stata 14.0. Five studies comprising 1360 hospitalized COVID-19 patients with mild to moderate cases were identified in the databases. Comparing the embolism incidence, we found that DOACs had a better effect than heparin, mainly low-molecular-weight heparin (LMWH), in preventing thromboembolism (risk ratio [RR] = 0.63, 95% confidence interval [CI] [0.43-0.91], P = 0.014). Considering safety, DOACs resulted in less bleeding than heparin during hospitalization (RR = 0.52, 95% CI [0.11-2.44], P = 0.411). Similar mortality was discovered in the 2 groups (RR = 0.94, 95% CI [0.59-1.51], P = 0.797). In noncritically hospitalized patients with COVID-19, DOACs are superior to heparin, even LMWH, in preventing thromboembolism. Compared with heparin, DOACs have a lower trend of bleeding and yield a similar mortality rate. Therefore, DOACs may be a better alternative for patients with mild to moderate COVID-19.

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“…The complex relationship between SARS-CoV-2 infection and hemostatic dysfunction observed in COVID-19 patients is still not fully understood, and treatment outcomes remain unsatisfactory 32 . While antithrombotic treatment does not appear to protect against morbidity and mortality, there is a need for effective therapy to reduce the incidence of thromboembolic complications and improve outcomes 33 – 35 .…”

Section: Introductionmentioning

confidence: 99%

Antiplatelet therapy prior to COVID-19 infection impacts on patients mortality: a propensity score-matched cohort study

Sokolski,

Reszka,

Adamik

et al. 2024

Sci Rep

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One of the major pathomechanisms of COVID-19 is the interplay of hyperinflammation and disruptions in coagulation processes, involving thrombocytes. Antiplatelet therapy (AP) by anti-inflammatory effect and inhibition of platelet aggregation may affect these pathways. The aim of this study was to investigate if AP has an impact on the in-hospital course and medium-term outcomes in hospitalized COVID-19 patients. The study population (2170 COVID-19 patients: mean ± SD age 60 ± 19 years old, 50% male) was divided into a group of 274 patients receiving any AP prior to COVID-19 infection (AP group), and after propensity score matching, a group of 274 patients without previous AP (non-AP group). Patients from the AP group were less frequently hospitalized in the intensive care unit: 9% vs. 15%, 0.55 (0.33–0.94), developed less often shock: 9% vs. 15%, 0.56 (0.33–0.96), and required less aggressive forms of therapy. The AP group had more coronary revascularizations: 5% vs. 1%, 3.48 (2.19–5.55) and strokes/TIA: 5% vs. 1%, 3.63 (1.18–11.2). The bleeding rate was comparable: 7% vs. 7%, 1.06 (0.54–2.06). The patients from the AP group had lower 3-month mortality: 31% vs. 39%, 0.69 (0.51–0.93) and didn’t differ significantly in 6-month mortality: 34% vs. 41%, 0.79 (0.60–1.04). When analyzing the subgroup with a history of myocardial infarction and/or coronary revascularization and/or previous stroke/transient ischemic attack and/or peripheral artery disease, AP had a beneficial effect on both 3-month: 37% vs. 56%, 0.58 (0.40–0.86) and 6-month mortality: 42% vs. 57%, 0.63 (0.44–0.92). Moreover, the favourable effect was highly noticeable in this subgroup where acetylsalicylic acid was continued during hospitalization with reduction of in-hospital: 19% vs. 43%, 0.31 (0.15–0.67), 3-month: 30% vs. 54%, 044 (0.26–0.75) and 6-month mortality: 33% vs. 54%, 0.49 (0.29–0.82) when confronted with the subgroup who had acetylsalicylic acid suspension during hospitalization. The AP may have a beneficial impact on hospital course and mortality in COVID-19 and shouldn’t be discontinued, especially in high-risk patients.

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Effect on Morbidity and Mortality of Direct Oral Anticoagulants in Patients With COVID-19

Cited by 10 publications

References 11 publications

Direct oral anticoagulants (DOAC) for patients with atrial fibrillation during the COVID-19 pandemic

Direct oral anticoagulants (DOAC) for patients with atrial fibrillation during the COVID-19 pandemic

Efficacy and Safety of Direct Oral Anticoagulants Compared With Heparin for Preventing Thromboembolism in Hospitalized Patients With COVID-19: A Systematic Review and Meta-Analysis

Antiplatelet therapy prior to COVID-19 infection impacts on patients mortality: a propensity score-matched cohort study

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