Excess mortality in a population of vitamin k antagonist users during the first wave of the COVID-19 pandemic in thenetherlands compared with excess mortality in the general dutch population

ABSTRACT

Background: Excess mortality has been observed in the general population during the COVID-19 pandemic, but it is unknown whether preexisting anticoagulant treatment affects survival, given that COVID-19 associated hypercoagulability adversely impacts prognosis. Aims: To investigate whether preexisting vitamin K antagonist (VKA) treatment is associated with lower excess mortality during the first wave of the COVID-19 pandemic in the Netherlands when compared with excess mortality in the general population. Methods: All atrial fibrillation (AF) patients (≥60 years) receiving long-term VKA therapy before week 11, 2020 were included from three Dutch anticoagulation clinics. The corresponding patient population managed by the same clinics in 2019 (i.e., all AF patients (≥60 years) receiving long-term VKA therapy before week 11, 2019) was enrolled as a control cohort. Difference in survival within 9 weeks (i.e., week 11 to 19) between the two cohorts was evaluated by Cox regression analysis. This was compared with the difference in survival during the same time frame of the general elderly (≥60 years) Dutch populations in 2020 versus 2019. Results: The study included 22,730 VKA users for the cohort in 2019 and 19,476 for the cohort in 2020, of which baseline characteristics were comparable. The cumulative incidences for all-cause mortality of the VKA users and the general population are presented in Table 1. Conclusions: Elderly patients with AF receiving long-term VKA therapy in the Netherlands appeared to have a lower excess mortality during the first wave of the COVID-19 pandemic when compared to the general elderly population.