tetano
Editor, Senior Moderator
Cardiovasc Diabetol
. 2021 Sep 4;20(1):176.
doi: 10.1186/s12933-021-01368-6.
Efficacy and safety of direct-acting oral anticoagulants compared to vitamin K antagonists in COVID-19 outpatients with cardiometabolic diseases
José Miguel Rivera-Caravaca[SUP] 1 2 3 [/SUP], Stephanie L Harrison[SUP] 1 4 [/SUP], Benjamin J R Buckley[SUP] 1 4 [/SUP], Elnara Fazio-Eynullayeva[SUP] 5 [/SUP], Paula Underhill[SUP] 6 [/SUP], Francisco Marín[SUP] 2 [/SUP], Gregory Y H Lip[SUP] 7 8 9 [/SUP]
Affiliations
Abstract
Background: It remains uncertain if prior use of oral anticoagulants (OACs) in COVID-19 outpatients with multimorbidity impacts prognosis, especially if cardiometabolic diseases are present. Clinical outcomes 30-days after COVID-19 diagnosis were compared between outpatients with cardiometabolic disease receiving vitamin K antagonist (VKA) or direct-acting OAC (DOAC) therapy at time of COVID-19 diagnosis.
Methods: A study was conducted using TriNetX, a global federated health research network. Adult outpatients with cardiometabolic disease (i.e. diabetes mellitus and any disease of the circulatory system) treated with VKAs or DOACs at time of COVID-19 diagnosis between 20-Jan-2020 and 15-Feb-2021 were included. Propensity score matching (PSM) was used to balance cohorts receiving VKAs and DOACs. The primary outcomes were all-cause mortality, intensive care unit (ICU) admission/mechanical ventilation (MV) necessity, intracranial haemorrhage (ICH)/gastrointestinal bleeding, and the composite of any arterial or venous thrombotic event(s) at 30-days after COVID-19 diagnosis.
Results: 2275 patients were included. After PSM, 1270 patients remained in the study (635 on VKAs; 635 on DOACs). VKA-treated patients had similar risks and 30-day event-free survival than patients on DOACs regarding all-cause mortality, ICU admission/MV necessity, and ICH/gastrointestinal bleeding. The risk of any arterial or venous thrombotic event was 43% higher in the VKA cohort (hazard ratio 1.43, 95% confidence interval 1.03-1.98; Log-Rank test p = 0.029).
Conclusion: In COVID-19 outpatients with cardiometabolic diseases, prior use of DOAC therapy compared to VKA therapy at the time of COVID-19 diagnosis demonstrated lower risk of arterial or venous thrombotic outcomes, without increasing the risk of bleeding.
Keywords: Anticoagulant; Bleeding; Coronavirus disease 2019; Direct-acting oral anticoagulants; SARS-CoV-2; Thrombosis; Vitamin K antagonist.
. 2021 Sep 4;20(1):176.
doi: 10.1186/s12933-021-01368-6.
Efficacy and safety of direct-acting oral anticoagulants compared to vitamin K antagonists in COVID-19 outpatients with cardiometabolic diseases
José Miguel Rivera-Caravaca[SUP] 1 2 3 [/SUP], Stephanie L Harrison[SUP] 1 4 [/SUP], Benjamin J R Buckley[SUP] 1 4 [/SUP], Elnara Fazio-Eynullayeva[SUP] 5 [/SUP], Paula Underhill[SUP] 6 [/SUP], Francisco Marín[SUP] 2 [/SUP], Gregory Y H Lip[SUP] 7 8 9 [/SUP]
Affiliations
- PMID: 34481513
- DOI: 10.1186/s12933-021-01368-6
Abstract
Background: It remains uncertain if prior use of oral anticoagulants (OACs) in COVID-19 outpatients with multimorbidity impacts prognosis, especially if cardiometabolic diseases are present. Clinical outcomes 30-days after COVID-19 diagnosis were compared between outpatients with cardiometabolic disease receiving vitamin K antagonist (VKA) or direct-acting OAC (DOAC) therapy at time of COVID-19 diagnosis.
Methods: A study was conducted using TriNetX, a global federated health research network. Adult outpatients with cardiometabolic disease (i.e. diabetes mellitus and any disease of the circulatory system) treated with VKAs or DOACs at time of COVID-19 diagnosis between 20-Jan-2020 and 15-Feb-2021 were included. Propensity score matching (PSM) was used to balance cohorts receiving VKAs and DOACs. The primary outcomes were all-cause mortality, intensive care unit (ICU) admission/mechanical ventilation (MV) necessity, intracranial haemorrhage (ICH)/gastrointestinal bleeding, and the composite of any arterial or venous thrombotic event(s) at 30-days after COVID-19 diagnosis.
Results: 2275 patients were included. After PSM, 1270 patients remained in the study (635 on VKAs; 635 on DOACs). VKA-treated patients had similar risks and 30-day event-free survival than patients on DOACs regarding all-cause mortality, ICU admission/MV necessity, and ICH/gastrointestinal bleeding. The risk of any arterial or venous thrombotic event was 43% higher in the VKA cohort (hazard ratio 1.43, 95% confidence interval 1.03-1.98; Log-Rank test p = 0.029).
Conclusion: In COVID-19 outpatients with cardiometabolic diseases, prior use of DOAC therapy compared to VKA therapy at the time of COVID-19 diagnosis demonstrated lower risk of arterial or venous thrombotic outcomes, without increasing the risk of bleeding.
Keywords: Anticoagulant; Bleeding; Coronavirus disease 2019; Direct-acting oral anticoagulants; SARS-CoV-2; Thrombosis; Vitamin K antagonist.