Management and impact of atrial fibrillation in the COVID 19 era;Concomitancy of two procoagulant phenomena

ABSTRACT

Background: Atrial fibrillation (AF) is a widespread cause of prothrombotic state leading to long-term anticoagulant therapy. Literature describes coagulopathy as a key pathogenic mechanism of COVID-19 disease. Thus, antithrombotic therapy management is still a therapeutic challenge. During hospitalization, changing oral anticoagulant (OAC) therapies into subcutaneous heparin is common in daily clinical practice. Purpose: The primary endpoint of this study is to analyze the impact of AF in mortality within 30 day since admission of COVID-19 patients. The secondary endpoint is to analyze the impact of the anticoagulant therapy strategy (therapeutic dose of subcutaneous heparin vs. OAC) in 30-day mortality of hospitalized COVID-19 patients with AF. Methods: A total of 1001 consecutive patients hospitalized in our centre between 22nd August and 9th January 2021 with a confirmed microbiological diagnosis of COVID-19 by PCR were prospectively included. Of them, 134 had a previous diagnose of AF (13.5%). Cox regression analysis was performed to assess the impact of AF and the choice of anticoagulant therapy in 30-day mortality after adjusting for comorbidity (Charlson Comorbidity Index). Results: After adjusting for comorbidities, AF was not independently associated with a higher 30-day mortality in patients hospitalized due to COVID-19 infection (HR 1.04, CI 0.77-1.43, p=0.760). In the group of patients with AF, changing OAC to heparin therapy was not associated with an improved prognosis (HR 0.85, CI 95% 0.46-1.56, p=0.604). Conclusions: AF is not an independent prognostic factor in COVID-19 hospitalized patients. In hospitalized COVID-19 patients with AF, changing OAC to heparin therapy is not related to an improved prognosis.