Pre-Admission Oral Anticoagulation Is Associated With Fewer Thrombotic Complications in Patients Admitted With Covid-19

Louis, David; Kennedy, Kevin F.; Saad, Marwan; Salber, Gregory; Imran, Hafiz Muhammad; Wark, Tyler; Soares, Cullen; Ghosalkar, Dhairyasheel; Cherala, Rasan; Poppas, Athena; Abbott, J. Dawn; Aronow, Herbert D.

doi:10.1016/s0735-1097(22)02789-9

Cited by 5 publications

(2 citation statements)

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“…Após a avaliação final, restaram 10 manuscritos elegíveis para inclusão nesta metanálise. [22][23][24][25][26][27][28][29][30][31] Foram incluídos 1.177.858 pacientes, dos quais 893.772 (75,9%) estavam em uso de anticoagulantes para FA antes da infecção por COVID-19. A média de idade variou de 71 a 82 anos e 629.628 pacientes eram do sexo masculino (55,5%).…”

Section: Resultsunclassified

Chronic Anticoagulation in Patients with Atrial Fibrillation and COVID-19: A Systematic Review and Meta-Analysis

Landsteiner,

Pinheiro,

Felix

et al. 2024

Arq. Bras. Cardiol.

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Background: Coronavirus disease 2019 (COVID-19) is associated with hypercoagulability. It remains uncertain whether ongoing anticoagulation for atrial fibrillation (AF) in patients who later contract COVID-19 improves clinical outcomes. Objectives: To compare chronic oral anticoagulation with no previous anticoagulation in patients with AF who contracted a COVID-19 infection concerning the outcomes of all-cause mortality, COVID-19 mortality, intensive care unit (ICU) admission, and hospitalization. Methods: We systematically searched PubMed, Embase, and Cochrane Library for eligible studies from inception to December 2022. We included studies comparing COVID-19 outcomes in patients with versus without prior chronic anticoagulation for AF. Risk ratios (RR) with 95% confidence intervals (CI) were pooled with a random-effects model. The level of significance was set at p < 0.05. Quality assessment and risk of bias were performed according to Cochrane recommendations. Results: Ten studies comprising 1,177,858 patients with COVID-19 and AF were identified, of whom 893,772 (75.9%) were on prior chronic anticoagulation for AF. In patients with COVID-19, being on chronic anticoagulation for AF significantly reduced all-cause mortality (RR 0.75; 95% CI 0.57 to 0.99; p = 0.048; I2 = 89%) and COVID-19-related mortality (RR 0.76; 95% CI 0.72 to 0.79; p < 0.001; I2 = 0%) when compared with no prior anticoagulation. In contrast, there was no difference between groups regarding hospitalization (RR 1.08; 95% CI 0.82 to 1.41; p = 0.587; I2 = 95%) or ICU admission (RR 0.86; 95% CI 0.68 to 1.09; p = 0.216; I2 = 69%). Conclusions: In this meta-analysis, chronic anticoagulation for patients with AF who contracted COVID-19 was associated with significantly lower rates of all-cause mortality and COVID-19-related mortality as compared with no previous anticoagulation.

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