The effect of chronic DOAC treatment on clinical outcomes of hospitalized patients with COVID‐19

Abstract

Background Recent findings indicate that thrombosis is one of the underlying pathophysiology and complication of COVID‐19 infection. Therefore, the prognosis of the disease may be more favourable in people who were under oral anticoagulant treatment before the COVID‐19 diagnosis. This study aims to evaluate the effects of chronic DOAC use on ICU admission and mortality in hospitalized patients due to COVID‐19 infection. Method Between 1 September and 30 November 2020, 2760 patients hospitalized in our hospital due to COVID‐19 were screened. A total of 1710 patients who met the inclusion criteria were included in the study. The patients were divided into two groups as those who use DOAC due to any cardiovascular disease before the COVID‐19 infection and those who do not. Results Seventy‐nine patients were enrolled in the DOAC group and 1631 patients in the non‐DOAC group. Median age of all study patient was 62 (52‐71 IQR) and 860 (50.5%) of them were female. The need for intensive care, in‐hospital stay, and mechanical ventilation were observed at higher rates in the DOAC group. Mortality was observed in 23 patients (29%) in the DOAC group, and it was statistically higher in the DOAC group ( P = .002). In the multivariable analysis, age (OR: 1.047, CI: 1.02‐1.06, P < .001), male gender (OR: 1.8, CI: 1.3‐2.7, P = .02), lymphocyte count (OR: 0.45, CI: 0.30‐0.69, P < .001), procalcitonin (OR: 1.12, CI: 1.02‐1.23, P = .015), SaO 2 (OR: 0.8, CI: 0.77‐0.82, P < .001) and creatinine (OR: 2.59, CI: 1.3‐5.1, P = .006) were found to be associated with in‐hospital mortality. DOAC treatment was not found to be associated with lower in‐hospital mortality in multivariable analysis (OR:1.17, CI: 0.20‐6.60, P = .850). Conclusion Our study showed that the use of DOAC prior to hospitalization had no protective effect on in‐hospital mortality and intensive care need in hospitalized COVID‐19 patients.

The Use of Oral Anticoagulation Is Not Associated With a Reduced Risk of Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis of Cohort Studies

“…Approximately half of VTE incidence occurred at or within 24 h of admission ( Lodigiani et al, 2020 ). Therefore, it was hypothesized that in the early stages of COVID-19, the transition from asymptomatic to severe respiratory failure might be sudden, and the anticoagulation therapy started after the advanced stage of COVID-19 may be insufficient ( Aslan et al, 2021 ). The oral anticoagulation (OAC) treatment prior to the earliest stages of COVID-19 infection may exert a protective effect for COVID-19-related outcomes.…”

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

“…Cochran Q heterogeneity test and I 2 statistic were performed to estimate the heterogeneity. The search yielded 3,474 articles; after deduplication and applying the inclusion criteria, 5 articles 3 , 4 , 5 , 6 were included in the data extraction ( Figure 1 ). The total number of patients with COVID-19 in the included articles was 148,027.…”

Vitamin K in COVID-19—Potential Anti-COVID-19 Properties of Fermented Milk Fortified with Bee Honey as a Natural Source of Vitamin K and Probiotics

“…Mortality was observed in 23 patients (29%) in the OAT group, and it was statistically higher than mortality in the non-OAT-using group (p = 0.002). The multivariate analysis noted that in-hospital mortality was associated with old age, male gender, lymphocyte count, procalcitonin, SaO2, and creatinine in OAT treatment [77]. In another study, analysis adjusted for age, gender, and comorbidity revealed no effect of OAT on mortality among 101 nursing home residents struck by COVID-19 [78].…”

“…Given the uncertainty concerning the potential benefits of the anticoagulant medication against COVID-19 and related complications [75,77,78], the use of foods rich in vitamin K may be a safer approach to protect against coagulopathy among high-risk groups. Although most food composition databases are the most complete for PK, interest has been directed toward MKs because of their high bioactivities relative to PK.…”