Association between warfarin and COVID-19-related outcomes compared with direct oral anticoagulants: population-based cohort study.
J Hematol Oncol
; 14(1): 172, 2021 10 19.
Article
in English
| MEDLINE | ID: covidwho-1477441
ABSTRACT
BACKGROUND:
Thromboembolism has been reported as a consequence of severe COVID-19. Although warfarin is a commonly used anticoagulant, it acts by antagonising vitamin K, which is low in patients with severe COVID-19. To date, the clinical evidence on the impact of regular use of warfarin on COVID-19-related thromboembolism is lacking.METHODS:
On behalf of NHS England, we conducted a population-based cohort study investigating the association between warfarin and COVID-19 outcomes compared with direct oral anticoagulants (DOACs). We used the OpenSAFELY platform to analyse primary care data and pseudonymously linked SARS-CoV-2 antigen testing data, hospital admissions and death records from England. We used Cox regression to estimate hazard ratios (HRs) for COVID-19-related outcomes comparing warfarin with DOACs in people with non-valvular atrial fibrillation. We also conducted negative control outcome analyses (being tested for SARS-CoV-2 and non-COVID-19 death) to assess the potential impact of confounding.RESULTS:
A total of 92,339 warfarin users and 280,407 DOAC users were included. We observed a lower risk of all outcomes associated with warfarin versus DOACs [testing positive for SARS-CoV-2, HR 0.73 (95% CI 0.68-0.79); COVID-19-related hospital admission, HR 0.75 (95% CI 0.68-0.83); COVID-19-related deaths, HR 0.74 (95% CI 0.66-0.83)]. A lower risk of negative control outcomes associated with warfarin versus DOACs was also observed [being tested for SARS-CoV-2, HR 0.80 (95% CI 0.79-0.81); non-COVID-19 deaths, HR 0.79 (95% CI 0.76-0.83)].CONCLUSIONS:
Overall, this study shows no evidence of harmful effects of warfarin on severe COVID-19 disease.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Thromboembolism
/
Warfarin
/
COVID-19
/
Anticoagulants
Type of study:
Cohort study
/
Observational study
/
Prognostic study
Limits:
Adolescent
/
Adult
/
Aged
/
Humans
/
Middle aged
/
Young adult
Country/Region as subject:
Europa
Language:
English
Journal:
J Hematol Oncol
Journal subject:
Hematology
/
Neoplasms
Year:
2021
Document Type:
Article
Affiliation country:
S13045-021-01185-0
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