Oral anticoagulation and clinical outcomes in COVID-19: An Italian multicenter experience

Abstract

Background Since the body of evidence addressing the coagulation derangements caused by Coronavirus disease (COVID-19) has been constantly growing, we investigated whether pre-hospitalization oral anticoagulation (OAC) or in-hospital heparin treatment could have a protective role among COVID-19 patients. Method In this cohort study, consecutive COVID-19 patients admitted to four different Italian Institutions were enrolled. Baseline demographic, clinical, laboratory, and radiological characteristics, as well as in-hospital treatment and outcomes were evaluated. The primary outcome was mortality. Results A total of 844 COVID-19 patients were enrolled as study cohort, n = 65 (7.7%) taking OACs prior to hospitalization. Regarding clinical outcomes, OAC patients developed acute hypoxemic respiratory failure (AHRF) more frequently than non-OAC patients as well as presenting a higher mortality rate (44.6% vs 19.8%, p < 0.001). At overall multivariate logistical regression, use of heparin ( n = 394, 46.6%) was associated with a better chance of survival to hospital discharge (OR 0.60 [0.38–0.94], p < 0.001), in particular in patients with AHRF, with no association found with the use of OACs. In a sub-analysis, the highest mortality rate was found for AHRF patients when heparin was not administered. Conclusion In our cohort, OACs appeared to be ineffective in reducing mortality rate, while heparin resulted to be a useful treatment when lung disease was sufficiently severe, potentially suggesting a crucial role of microthrombosis in severe COVID-19. Due to the relatively small number of COVID-19 patients treated with OACs included in our analysis and their higher number of comorbidities, larger studies are needed in order to confirm our findings.

Direct oral anticoagulant use and risk of severe COVID‐19

“…Preemptive anticoagulant treatment before or at the time of SARS-CoV-2 infection to protect against severe disease is theoretically appealing but real-world data have been lacking. Previously, only small studies of COVID-19 patient cohorts have been conducted showing mixed results [6][7][8][9][10][11][12][13]. An additional case-control study aimed at investigating the association between renin-angiotensin-aldosterone system blockers and COVID-19 reported also on oral anticoagulant use (odds ratio, 1.16; 95% CI 1.04-1.30) [19].…”

Impact of prior statin use on clinical outcomes in COVID-19 patients: data from tertiary referral hospitals during COVID-19 pandemic in Italy

“…In particular, patients with pre-existing cardiovascular disease (CVD) have an elevated risk of adverse outcomes, and, on the other hand, SARS-CoV-2 infection is associated with vascular and arrhythmic complications. 10 , 11 , 12 , 7 , 8 , 9 …”

Pragmatic Recommendations for the Management of Anticoagulation and Venous Thrombotic Disease for Hospitalized Patients with COVID-19 in Low- and Middle-Income Countries

“…Patients on DOAC developed acute hypoxemic respiratory failure more frequently than non-DOAC patients and experienced a higher mortality rate (44.6% versus 19.8%, P < 0.001). 67 Once there is clinical improvement and plan to discharge, patients with VTE can be switched to a DOAC or vitamin K antagonist with plan to treat for at least a total of 3 months.…”