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Association between warfarin and COVID-19-related outcomes compared with direct oral anticoagulants: population-based cohort study.
Wong, Angel Y S; Tomlinson, Laurie A; Brown, Jeremy P; Elson, William; Walker, Alex J; Schultze, Anna; Morton, Caroline E; Evans, David; Inglesby, Peter; MacKenna, Brian; Bhaskaran, Krishnan; Rentsch, Christopher T; Powell, Emma; Williamson, Elizabeth; Croker, Richard; Bacon, Seb; Hulme, William; Bates, Chris; Curtis, Helen J; Mehrkar, Amir; Cockburn, Jonathan; McDonald, Helen I; Mathur, Rohini; Wing, Kevin; Forbes, Harriet; Eggo, Rosalind M; Evans, Stephen J W; Smeeth, Liam; Goldacre, Ben; Douglas, Ian J.
  • Wong AYS; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. Angel.Wong@lshtm.ac.uk.
  • Tomlinson LA; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
  • Brown JP; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
  • Elson W; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
  • Walker AJ; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Schultze A; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
  • Morton CE; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Evans D; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Inglesby P; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • MacKenna B; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Bhaskaran K; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
  • Rentsch CT; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
  • Powell E; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
  • Williamson E; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
  • Croker R; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Bacon S; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Hulme W; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Bates C; TPP, TPP House, Horsforth, Leeds, UK.
  • Curtis HJ; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Mehrkar A; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
  • Cockburn J; TPP, TPP House, Horsforth, Leeds, UK.
  • McDonald HI; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
  • Mathur R; NIHR Health Protection Research Unit (HPRU) in Immunisation, London, UK.
  • Wing K; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
  • Forbes H; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
  • Eggo RM; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
  • Evans SJW; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
  • Smeeth L; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
  • Goldacre B; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
  • Douglas IJ; NIHR Health Protection Research Unit (HPRU) in Immunisation, London, UK.
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thromboembolism / Warfarin / COVID-19 / Anticoagulants Type of study: Etiology study / Incidence study / Observational study / Risk factors 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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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thromboembolism / Warfarin / COVID-19 / Anticoagulants Type of study: Etiology study / Incidence study / Observational study / Risk factors 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