Clinical profile and prognosis in patients on oral anticoagulation before admission for COVID-19

José Miguel Rivera-Caravaca, Iván J Núñez-Gil, David Vivas, María C Viana-Llamas, Aitor Uribarri, Víctor Manuel Becerra-Muñoz, Daniela Trabattoni, Inmaculada Fernández Rozas, Gisela Feltes, Javier López-Pais, Ibrahim El-Battrawy, Carlos Macaya, Antonio Fernandez-Ortiz, Vicente Estrada, Francisco Marín, HOPE COVID-19 Investigators, José Miguel Rivera-Caravaca, Iván J Núñez-Gil, David Vivas, María C Viana-Llamas, Aitor Uribarri, Víctor Manuel Becerra-Muñoz, Daniela Trabattoni, Inmaculada Fernández Rozas, Gisela Feltes, Javier López-Pais, Ibrahim El-Battrawy, Carlos Macaya, Antonio Fernandez-Ortiz, Vicente Estrada, Francisco Marín, HOPE COVID-19 Investigators

Abstract

Background: The coronavirus disease 2019 (COVID-19) shows high morbidity and mortality, particularly in patients with concomitant cardiovascular diseases. Some of these patients are under oral anticoagulation (OAC) at admission, but to date, there are no data on the clinical profile, prognosis and risk factors of such patients during hospitalization for COVID-19.

Design: Subanalysis of the international 'real-world' HOPE COVID-19 registry. All patients with prior OAC at hospital admission for COVID-19 were suitable for the study. All-cause mortality was the primary endpoint.

Results: From 1002 patients included, 110 (60.9% male, median age of 81.5 [IQR 75-87] years, median Short-Form Charlson Comorbidity Index [CCI] of 1 [IQR 1-3]) were on OAC at admission, mainly for atrial fibrillation and venous thromboembolism. After propensity score matching, 67.9% of these patients died during hospitalization, which translated into a significantly higher mortality risk compared to patients without prior OAC (HR 1.53, 95% CI 1.08-2.16). After multivariate Cox regression analysis, respiratory insufficiency during hospitalization (HR 6.02, 95% CI 2.18-16.62), systemic inflammatory response syndrome (SIRS) during hospitalization (HR 2.29, 95% CI 1.34-3.91) and the Short-Form CCI (HR 1.24, 95% CI 1.03-1.49) were the main risk factors for mortality in patients on prior OAC.

Conclusions: Compared to patients without prior OAC, COVID-19 patients on OAC therapy at hospital admission showed lower survival and higher mortality risk. In these patients on OAC therapy, the prevalence of several comorbidities is high. Respiratory insufficiency and SIRS during hospitalization, as well as higher comorbidity, pointed out those anticoagulated patients with increased mortality risk.

Keywords: Coronavirus disease 2019; SARS-CoV-2; anticoagulant; atrial fibrillation; thrombosis; venous thromboembolism.

Conflict of interest statement

None declared.

© 2020 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Mortality‐free survival depending on the previous use of oral anticoagulation therapy. Solid line = patients without prior oral anticoagulation at hospital admission. Dashed line = patients on prior oral anticoagulation at hospital admission
Figure 2
Figure 2
Cumulative hazard with 95% confidence interval of the predictive model for the primary outcome in patients with prior oral anticoagulation therapy

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