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

• Published in: European Journal of Clinical Investigation Vol. 51; no. 1; pp. e13436 - n/a
• Main Authors: Rivera‐Caravaca, José Miguel, Núñez‐Gil, Iván J., Vivas, David, Viana‐Llamas, María C., Uribarri, Aitor, Becerra‐Muñoz, Víctor Manuel, Trabattoni, Daniela, Fernández Rozas, Inmaculada, Feltes, Gisela, López‐Pais, Javier, El‐Battrawy, Ibrahim, Macaya, Carlos, Fernandez‐Ortiz, Antonio, Estrada, Vicente, Marín, Francisco
• Format: Journal Article Web Resource
• Language: English
• Published: England John Wiley & Sons, Inc 01.01.2021; Blackwell Publishing Ltd; John Wiley and Sons Inc
• Subjects: Aged; Aged, 80 and over; anticoagulant; Anticoagulants; Anticoagulants - therapeutic use; atrial fibrillation; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Cardiovascular diseases; Comorbidity; Coronavirus disease 2019; Coronaviruses; COVID-19; COVID-19 - mortality; Factor Xa Inhibitors - therapeutic use; Female; Fibrillation; Heart Failure - epidemiology; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Heparin - therapeutic use; Heparin, Low-Molecular-Weight - therapeutic use; Hospital Mortality; Hospitalization; Humans; Inflammation; Inflammatory response; Intensive Care Units; Male; Medical prognosis; Morbidity; Mortality; Multivariate Analysis; Original; Original Papers; Patients; Prognosis; Propensity Score; Proportional Hazards Models; Regression analysis; Renal Insufficiency - epidemiology; Respiration, Artificial; Respiratory Insufficiency - epidemiology; Risk analysis; Risk Factors; SARS-CoV-2; Sepsis - epidemiology; Systemic inflammatory response syndrome; Systemic Inflammatory Response Syndrome - epidemiology; Thromboembolism; Thromboembolism - epidemiology; thrombosis; venous thromboembolism; Venous Thromboembolism - drug therapy; Venous Thromboembolism - epidemiology; Viral diseases; SARS-CoV-2; atrial fibrillation; thrombosis; anticoagulant; Coronavirus disease 2019; venous thromboembolism
• ISSN: 0014-2972; 1365-2362
• DOI: 10.1111/eci.13436

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.