Chronic Oral Anticoagulation Therapy and Prognosis of Patients Admitted to Hospital for COVID-19: Insights from the HOPE COVID-19 Registry

José Miguel Rivera-Caravaca, Iván J Núñez-Gil, Gregory Y H Lip, Aitor Uribarri, María C Viana-Llamas, Adelina Gonzalez, Alex F Castro-Mejía, Berta Alonso González, Emilio Alfonso, Juan Fortunato García Prieto, Chiara Cavallino, Bernardo Cortese, Gisela Feltes, Inmaculada Fernández-Rozas, Jaime Signes-Costa, Jia Huang, Marcos García Aguado, Martino Pepe, Rodolfo Romero, Enrico Cerrato, Víctor Manuel Becerra-Muñoz, Sergio Raposeiras Roubin, Francesco Santoro, Rodrigo Bagur, Luciano Sposato, Ibrahim El-Battrawy, Alvaro López Masjuan, Antonio Fernandez-Ortiz, Vicente Estrada, Carlos Macaya, Francisco Marín, José Miguel Rivera-Caravaca, Iván J Núñez-Gil, Gregory Y H Lip, Aitor Uribarri, María C Viana-Llamas, Adelina Gonzalez, Alex F Castro-Mejía, Berta Alonso González, Emilio Alfonso, Juan Fortunato García Prieto, Chiara Cavallino, Bernardo Cortese, Gisela Feltes, Inmaculada Fernández-Rozas, Jaime Signes-Costa, Jia Huang, Marcos García Aguado, Martino Pepe, Rodolfo Romero, Enrico Cerrato, Víctor Manuel Becerra-Muñoz, Sergio Raposeiras Roubin, Francesco Santoro, Rodrigo Bagur, Luciano Sposato, Ibrahim El-Battrawy, Alvaro López Masjuan, Antonio Fernandez-Ortiz, Vicente Estrada, Carlos Macaya, Francisco Marín

Abstract

Background: Most evidence regarding anticoagulation and COVID-19 refers to the hospitalization setting, but the role of oral anticoagulation (OAC) before hospital admission has not been well explored. We compared clinical outcomes and short-term prognosis between patients with and without prior OAC therapy who were hospitalized for COVID-19.

Methods: Analysis of the whole cohort of the HOPE COVID-19 Registry which included patients discharged (deceased or alive) after hospital admission for COVID-19 in 9 countries. All-cause mortality was the primary endpoint. Study outcomes were compared after adjusting variables using propensity score matching (PSM) analyses.

Results: 7698 patients were suitable for the present analysis (675 (8.8%) on OAC at admission: 427 (5.6%) on VKAs and 248 (3.2%) on DOACs). After PSM, 1276 patients were analyzed (638 with OAC; 638 without OAC), without significant differences regarding the risk of thromboembolic events (OR 1.11, 95% CI 0.59-2.08). The risk of clinically relevant bleeding (OR 3.04, 95% CI 1.92-4.83), as well as the risk of mortality (HR 1.22, 95% CI 1.01-1.47; log-rank p value = 0.041), was significantly increased in previous OAC users. Amongst patients on prior OAC only, there were no differences in the risk of clinically relevant bleeding, thromboembolic events, or mortality when comparing previous VKA or DOAC users, after PSM.

Conclusion: Hospitalized COVID-19 patients on prior OAC therapy had a higher risk of mortality and worse clinical outcomes compared to patients without prior OAC therapy, even after adjusting for comorbidities using a PSM. There were no differences in clinical outcomes in patients previously taking VKAs or DOACs. This trial is registered with NCT04334291/EUPAS34399.

Conflict of interest statement

JMR-C has received an unrestricted educational grant from Bristol-Myers Squibb-Pfizer Alliance (BMS protocol number: CV185-805) for this study. GYHL is a consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, and Daiichi-Sankyo. Other authors declare that they have no conflicts of interest.

Copyright © 2022 José Miguel Rivera-Caravaca et al.

Figures

Figure 1
Figure 1
Comparison of survival curves between patients on prior OAC and nonprior OAC. Solid line, nonprior OAC; dashed line, prior OAC.
Figure 2
Figure 2
Comparison of survival curves between patients on prior VKAs or DOACs. Solid line, prior VKA use; dashed line, prior DOAC use.

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Source: PubMed

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