Protective role of chronic treatment with direct oral anticoagulants in elderly patients affected by interstitial pneumonia in COVID-19 era

Rossi, Rosario; Coppi, Francesca; Talarico, Marisa; Boriani, Giuseppe

doi:10.1016/j.ejim.2020.06.006

Cited by 70 publications

(91 citation statements)

References 9 publications

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“…Ultimately, 8 studies were included in the final qualitative synthesis (Figure 1). [12][13][14][15][16][17][18][19][20] The main features of the 8 studies are presented in Table 1.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…Furthermore, Rossi et al reported that the use of therapeutic-dose anticoagulation by DOAC administration was associated with lower mortality rate among elderly patients with COVID-19 (adjusted HR 0.38, 95% CI 0.17-0.58). 19 The remaining 5 studies showed no mortality benefits among patients with COVID-19 receiving therapeutic-dose anticoagulation (Table 1). 14,[16][17][18][19][20][21][22][23][24][25][26][27][28] The included studies consisted of 1 prospective cohort, 18 and 4 retrospective cohorts.…”

Section: Therapeutic-dose Anticoagulation and Mortalitymentioning

confidence: 99%

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The Use of Therapeutic-Dose Anticoagulation and Its Effect on Mortality in Patients With COVID-19: A Systematic Review

Wijaya

Andhika

Huang

2020

Clin Appl Thromb Hemost

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The incidence of venous thromboembolism (VTE) events in patients with COVID-19 treated with a standard thromboprophylaxis dose of anticoagulants remains high. We conducted a systematic review in order to explore the association between therapeutic-dose anticoagulation and its effect on mortality in patients with COVID-19. A systematic search was carried out using the electronic databases of PubMed, EuropePMC, and the Cochrane Central Database, using specific keywords. All articles that fulfilled the inclusion criteria were included in the qualitative analysis. There were 8 observational studies included in the final qualitative analysis. Quality assessment using the Newcastle-Ottawa Scale (NOS) showed a mean score of 7.5 ± 1.06, indicating moderate to high quality of the studies. Three retrospective cohort studies reported a reduction in the mortality rate, while 6 other studies showed no mortality benefits among patients with COVID-19 treated with therapeutic-dose anticoagulation. There was a slight tendency toward a reduction in the mortality rate among mechanically-ventilated patients with COVID-19 receiving therapeutic-dose anticoagulation. Bleeding events and thrombotic complications among patients receiving therapeutic-dose anticoagulation were reported in 3 studies. Although it is too soon to draw any conclusions, this systematic review draws attention to current evidence regarding the association between therapeutic-dose anticoagulation and its effect on mortality in patients with COVID-19.

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“…Ultimately, 8 studies were included in the final qualitative synthesis (Figure 1). [12][13][14][15][16][17][18][19][20] The main features of the 8 studies are presented in Table 1.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Section: Therapeutic-dose Anticoagulation and Mortalitymentioning

confidence: 99%

The Use of Therapeutic-Dose Anticoagulation and Its Effect on Mortality in Patients With COVID-19: A Systematic Review

Wijaya

Andhika

Huang

2020

Clin Appl Thromb Hemost

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“…Moreover, adipose cell embolism amplifies both the inflammatory phenomena and the pro-thrombotic status [9]. The latter is a well-known prognostic factor and chronic oral anti-coagulation showed a reduction in mortality in patients with chronic cardiac disease [10].…”

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confidence: 99%

Protective role of statins in COVID 19 patients: importance of pharmacokinetic characteristics rather than intensity of action

et al. 2020

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Statins represent a family of drugs that are potentially able to defend COVID-19 patients against uncontrolled systemic inflammatory response produced by the virus Sars-Cov-2. Therefore, some physicians proposed and used anti-inflammatory agents in the treatment regimen of patients with COVID-19 [1]. Statins are well known for their anti-inflammatory effects [2], and some hospitals included them in the COVID-19 treatment protocol [3]. In addition, studies in vitro verified that "there is evidence suggesting that statins exert anti-viral activity and may block the infectivity of enveloped viruses" [4]. In other words, statins could be efficient SARS-CoV-2 inhibitors of the main protease, a key coronavirus enzyme, which is a potential drug target [4]. Considering the above premises, we hypothesized that patients taking statins were better protected against mortality risk than those who do not take statins. We verified this hypothesis in a population of 71 consecutive patients with a pre-existing chronic cardiovascular disease, who become ill from COVID-19 between February 29, 2020, and May 20, 2020. The follow-up ended on June 15, 2020. The only endpoint of the study was all-cause mortality. Continuous variables were expressed as mean ± one SD or median (range) values; and categorical data as percentages. All dichotomous variables were compared utilizing the χ2 test; and continuous parameters using analysis of variance (ANOVA) or Mann-Whitney U test, as appropriate. Survival probabilities were estimated with the Kaplan-Meier method and survival curves plotted and compared between groups using the log-rank test. P < 0.05 was considered statistically significant.

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“…Recent retrospective studies evaluated whether the administration of anticoagulation and antiplatelet drugs had any protective effect on patients with COVID-19 and found conflicting results. 110,111 One study found no significant difference in outcomes, including mortality and mechanical ventilation; however, this study utilized a propensity-matched cohort, which limited the anticoagulation sample size to <150 patients and the authors do not clarify which anticoagulant was administered, if antiplatelets were given simultaneously, and there was no control for anticoagulation treatment regimen once admitted into the hospital. 110 The second study, also small with a patient population of 70, evaluated elderly patients with chronic heart disease that were on anticoagulants for at least 6 months prior to the diagnosis of COVID-19-related interstitial pneumonia and found that direct oral anticoagulants (DOACs), factor IIa and factor Xa inhibitors, appeared to be significantly protective.…”

Section: Factor Xa Inhibitors As a Potential Treatment For Covid-19mentioning

confidence: 97%

“…110 The second study, also small with a patient population of 70, evaluated elderly patients with chronic heart disease that were on anticoagulants for at least 6 months prior to the diagnosis of COVID-19-related interstitial pneumonia and found that direct oral anticoagulants (DOACs), factor IIa and factor Xa inhibitors, appeared to be significantly protective. 111 Although this is an important study and a step in the right direction, the authors acknowledge that more thorough studies need to be performed.…”

Section: Factor Xa Inhibitors As a Potential Treatment For Covid-19mentioning

confidence: 99%

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2020

TH Open

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Protective role of chronic treatment with direct oral anticoagulants in elderly patients affected by interstitial pneumonia in COVID-19 era

Cited by 70 publications

References 9 publications

The Use of Therapeutic-Dose Anticoagulation and Its Effect on Mortality in Patients With COVID-19: A Systematic Review

The Use of Therapeutic-Dose Anticoagulation and Its Effect on Mortality in Patients With COVID-19: A Systematic Review

Protective role of statins in COVID 19 patients: importance of pharmacokinetic characteristics rather than intensity of action

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