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Rivera-Caravaca, JM, Harrison, SL, Buckley, BJR, Fazio-Eynullayeva, E, Underhill, P, Marin, F and Lip, GYH (2021) Efficacy and safety of direct-acting oral anticoagulants compared to vitamin K antagonists in COVID-19 outpatients with cardiometabolic diseases. Cardiovascular Diabetology, 20 (1). ISSN 1475-2840
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Efficacy and safety of direct-acting oral anticoagulants compared to vitamin K antagonists in COVID-19 outpatients with cardiometabolic diseases.pdf - Published Version Available under License Creative Commons Attribution. Download (1MB) | Preview |
Abstract
Background: It remains uncertain if prior use of oral anticoagulants (OACs) in COVID-19 outpatients with multimorbidity impacts prognosis, especially if cardiometabolic diseases are present. Clinical outcomes 30-days after COVID-19 diagnosis were compared between outpatients with cardiometabolic disease receiving vitamin K antagonist (VKA) or direct-acting OAC (DOAC) therapy at time of COVID-19 diagnosis. Methods: A study was conducted using TriNetX, a global federated health research network. Adult outpatients with cardiometabolic disease (i.e. diabetes mellitus and any disease of the circulatory system) treated with VKAs or DOACs at time of COVID-19 diagnosis between 20-Jan-2020 and 15-Feb-2021 were included. Propensity score matching (PSM) was used to balance cohorts receiving VKAs and DOACs. The primary outcomes were all-cause mortality, intensive care unit (ICU) admission/mechanical ventilation (MV) necessity, intracranial haemorrhage (ICH)/gastrointestinal bleeding, and the composite of any arterial or venous thrombotic event(s) at 30-days after COVID-19 diagnosis. Results: 2275 patients were included. After PSM, 1270 patients remained in the study (635 on VKAs; 635 on DOACs). VKA-treated patients had similar risks and 30-day event-free survival than patients on DOACs regarding all-cause mortality, ICU admission/MV necessity, and ICH/gastrointestinal bleeding. The risk of any arterial or venous thrombotic event was 43% higher in the VKA cohort (hazard ratio 1.43, 95% confidence interval 1.03–1.98; Log-Rank test p = 0.029). Conclusion: In COVID-19 outpatients with cardiometabolic diseases, prior use of DOAC therapy compared to VKA therapy at the time of COVID-19 diagnosis demonstrated lower risk of arterial or venous thrombotic outcomes, without increasing the risk of bleeding.
| Item Type: | Article |
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| Uncontrolled Keywords: | Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Endocrinology & Metabolism; Cardiovascular System & Cardiology; Coronavirus disease 2019; SARS-CoV-2; Thrombosis; Anticoagulant; Vitamin K antagonist; Direct-acting oral anticoagulants; Bleeding; ATRIAL-FIBRILLATION; WARFARIN; DABIGATRAN; RIVAROXABAN; CORONAVIRUS; APIXABAN; GUIDANCE; EDOXABAN; Humans; Heart Diseases; Metabolic Diseases; Hemorrhage; Vitamin K; Anticoagulants; Treatment Outcome; Ambulatory Care; Administration, Oral; Mortality; Follow-Up Studies; Aged; Aged, 80 and over; Middle Aged; Intensive Care Units; Female; Male; Factor Xa Inhibitors; COVID-19; Anticoagulant; Bleeding; Coronavirus disease 2019; Direct-acting oral anticoagulants; SARS-CoV-2; Thrombosis; Vitamin K antagonist; Administration, Oral; Aged; Aged, 80 and over; Ambulatory Care; Anticoagulants; COVID-19; Factor Xa Inhibitors; Female; Follow-Up Studies; Heart Diseases; Hemorrhage; Humans; Intensive Care Units; Male; Metabolic Diseases; Middle Aged; Mortality; Treatment Outcome; Vitamin K; Cardiovascular System & Hematology; 1102 Cardiorespiratory Medicine and Haematology |
| Subjects: | R Medicine > RC Internal medicine > RC1200 Sports Medicine |
| Divisions: | Sport & Exercise Sciences |
| Publisher: | BMC |
| SWORD Depositor: | A Symplectic |
| Date Deposited: | 12 May 2022 09:56 |
| Last Modified: | 12 May 2022 10:00 |
| DOI or ID number: | 10.1186/s12933-021-01368-6 |
| URI: | https://researchonline.ljmu.ac.uk/id/eprint/16812 |
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