Impact of oral anticoagulation on clinical outcomes of COVID-19: a nationwide cohort study of hospitalized patients in Germany

Fröhlich, Georg; Jeschke, Elke; Eichler, Uwe; Thiele, Holger; Alhariri, Laila; Reinthaler, Markus; Kastrati, Adnan; Leistner, David M.; Skurk, Carsten; Landmesser, Ulf; Günster, Christian

doi:10.1007/s00392-020-01783-x

Cited by 53 publications

(67 citation statements)

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“…On the other hand, factors contributing to increased mortality are especially disorders of the coagulation system, or liver disease, as already known for in-hospital mortality. These data are in line with our current understanding of COVID, in particular disorders of the coagulation or cerebrovascular system (24)(25)(26).…”

Section: Discussionsupporting

confidence: 88%

6-Month Follow Up of 8679 Hospitalized COVID-19 Patients in Germany: A Nationwide Cohort Study

Guenster¹,

Busse

Spoden³

et al. 2021

Preprint

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Background: Data on long-term outcomes of hospitalized COVID-19 patients are scarce. Objective: To provide a detailed account of hospitalized COVID-19 patients until 180 days after their initial hospitalization. Design: Nationwide cohort study using claims data from the German Local Health Care Funds, the health insurer of one-third of the German population. Setting: Germany. Patients: Adult patients hospitalized in Germany between Feb 1 and April 30, 2020 with PCR-confirmed COVID-19 and a related principal diagnosis. Measurements: Patient characteristics and ventilation status, in-hospital, 30-, 90- and 180-day mortality measured from admission, and 180-day readmission measured from discharge. Multivariable logistic regression model of independent risk factors for 180-day mortality. Results: Of 8679 patients (median age, 72 years), 2161 (24.9%) died during the index hospitalization. 30-day mortality was 23.9% (2073/8679), 90-day mortality 27.9% (2425/8679), and 180-day mortality 29.6% (2566/8679). The latter was 52.3% (1472/2817) for patients aged ≥ 80 years, and 53.0% for patients who had been ventilated invasively (853/1608). Risk factors for 180-day mortality included coagulopathy, BMI ≥ 40, and age. Female sex was a protective factor. Of 6235 patients discharged alive, 1668 patients were readmitted a total of 2551 times within 180 days, resulting in an overall readmission rate of 26.8%. Limitations: We could not stratify patients by ICU treatment as it is not coded separately. Furthermore, we cannot exclude residual confounding in our analysis of risk factors nor determine causality between risk factors and long-term mortality given the observational nature of this study. Conclusion: This nationwide cohort study of hospitalized COVID-19 patients in Germany found considerable long-term mortality and readmission rates, especially among patients with coagulopathy. Close follow-up after hospital discharge may improve long-term outcome.

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Section: Discussionsupporting

confidence: 88%

6-Month Follow Up of 8679 Hospitalized COVID-19 Patients in Germany: A Nationwide Cohort Study

Guenster¹,

Busse

Spoden³

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

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“…Similarly, another study in Italy showed that elderly patients with COVID-19 on chronic OAC treatment for AF had lower all-cause mortality rate ratio compared to their PSM non-anticoagulated counterpart [24] . A further cohort study including hospitalized COVID-19 patients from Germany showed that pre-existing therapy with both DOACs or VKAs was associated with a lower risk for the primary endpoint (all-cause mortality or need for invasive or non-invasive ventilation or extracorporeal membrane oxygenation) [25] . Similarly, in COVID-19 patients initially admitted in medical wards of French hospitals, previous OAC with VKA or DOACs significantly decreased ICU admission or in-hospital mortality [26] .…”

Section: Discussionmentioning

confidence: 99%

Direct-acting oral anticoagulants use prior to COVID-19 diagnosis and associations with 30-day clinical outcomes

Rivera‐Caravaca

Buckley

Harrison

et al. 2021

Thrombosis Research

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Background It is unclear if direct-acting oral anticoagulants (DOACs) use before hospitalization due to COVID-19 diagnosis would potentially impact the severity and clinical outcomes thereafter. We compared 30-day hospitalization/re-hospitalization and clinical outcomes between patients on chronic DOAC therapy and patients not on oral anticoagulation (OAC) therapy at time of COVID-19 diagnosis. Methods We used data from TriNetX, a global federated health research network. Patients aged ≥18 years who were treated with DOACs at time of COVID-19 diagnosis between 20 January 2020 and 28 February 2021 were included, and matched with patients not on OAC therapy from the same period. All patients were followed-up at 30-days after COVID-19 diagnosis. The primary outcomes were all-cause mortality, hospitalization/re-hospitalization, venous thromboembolism (VTE) and intracranial hemorrhage (ICH). Results 738,423patients were included. After propensity score matching (PSM), 26,006 patients remained in the study (13,003 on DOACs; 13,003 not on OAC). DOAC-treated patients (mean age 67.1 ± 15.4 years, 52.2% male) had higher relative risks (RRs) and lower 30-days event-free survival as compared to patients not on OAC for all-cause mortality (RR 1.27, 95% CI 1.12–1.44; Log-Rank test p = 0.010), hospitalization/re-hospitalization (RR 1.72, 95% CI 1.64–1.82; Log-Rank test p < 0.001) and VTE (RR 4.51, 95% CI 3.91–5.82; Log-Rank test p < 0.001), but not for ICH (RR 0.90, 95% CI 0.54–1.51; Log-Rank test p = 0.513). Conclusion In COVID-19 patients, previous DOAC therapy at time of diagnosis was not associated with improved clinical outcomes or lower hospitalization/re-hospitalization rate compared to patients not taking OAC therapy.

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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%

“…Those studies included from 110 to 731 anticoagulated patients and from 98 to 912 patients on antiplatelet therapy, with highly heterogenous findings. 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 ].…”

Section: Discussionmentioning

confidence: 99%

“…Rivera-Caravaca et al found that patients on AC therapy at the time of hospital admission had lower survival rates and a greater mortality risk [ 23 ]. Finally, Chow and colleagues evaluated the role of previous antiplatelet therapy, finding that these patients had a lower risk of mechanical ventilation, ICU admission, and in-hospital mortality [ 30 ], results that contrast with the findings of the other studies [ 26 , 33 ].…”

Section: Discussionmentioning

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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Impact of oral anticoagulation on clinical outcomes of COVID-19: a nationwide cohort study of hospitalized patients in Germany

Cited by 53 publications

References 20 publications

6-Month Follow Up of 8679 Hospitalized COVID-19 Patients in Germany: A Nationwide Cohort Study

6-Month Follow Up of 8679 Hospitalized COVID-19 Patients in Germany: A Nationwide Cohort Study

Direct-acting oral anticoagulants use prior to COVID-19 diagnosis and associations with 30-day clinical outcomes

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

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