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Association between oral anticoagulants and COVID-19-related outcomes: a population-based cohort study.
Wong, Angel Ys; Tomlinson, Laurie; 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 Jw; Smeeth, Liam; Goldacre, Ben; Douglas, Ian J.
  • Wong AY; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London.
  • Tomlinson L; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London.
  • Brown JP; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London.
  • Elson W; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London.
  • Walker AJ; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
  • Schultze A; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London.
  • Morton CE; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
  • Evans D; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
  • Inglesby P; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
  • MacKenna B; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
  • Bhaskaran K; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London.
  • Rentsch CT; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London.
  • Powell E; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London.
  • Williamson E; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London.
  • Croker R; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
  • Bacon S; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
  • Hulme W; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
  • Bates C; TPP, Leeds.
  • Curtis HJ; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
  • Mehrkar A; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
  • Cockburn J; TPP, Leeds.
  • McDonald HI; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London and NIHR Health Protection Research Unit (HPRU) in Immunisation, London School of Hygiene and Tropical Medicine, London.
  • Mathur R; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London.
  • Wing K; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London.
  • Forbes H; Bristol Medical School, University of Bristol, Bristol.
  • Eggo RM; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London.
  • Evans SJ; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London.
  • Smeeth L; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London and NIHR Health Protection Research Unit (HPRU) in Immunisation, London School of Hygiene and Tropical Medicine, London.
  • Goldacre B; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
  • Douglas IJ; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London.
Br J Gen Pract ; 72(720): e456-e463, 2022 07.
Article in English | MEDLINE | ID: covidwho-1810374
ABSTRACT

BACKGROUND:

Early evidence has shown that anticoagulant reduces the risk of thrombotic events in those infected with COVID-19. However, evidence of the role of routinely prescribed oral anticoagulants (OACs) in COVID-19 outcomes is limited.

AIM:

To investigate the association between OACs and COVID-19 outcomes in those with atrial fibrillation and a CHA2DS2-VASc score of 2. DESIGN AND

SETTING:

On behalf of NHS England, a population-based cohort study was conducted.

METHOD:

The study used primary care data and pseudonymously-linked SARS-CoV-2 antigen testing data, hospital admissions, and death records from England. Cox regression was used to estimate hazard ratios (HRs) for COVID-19 outcomes comparing people with current OAC use versus non-use, accounting for age, sex, comorbidities, other medications, deprivation, and general practice.

RESULTS:

Of 71 103 people with atrial fibrillation and a CHA2DS2-VASc score of 2, there were 52 832 current OAC users and 18 271 non-users. No difference in risk of being tested for SARS-CoV-2 was associated with current use (adjusted HR [aHR] 0.99, 95% confidence interval [CI] = 0.95 to 1.04) versus non-use. A lower risk of testing positive for SARS-CoV-2 (aHR 0.77, 95% CI = 0.63 to 0.95) and a marginally lower risk of COVID-19-related death (aHR, 0.74, 95% CI = 0.53 to 1.04) were associated with current use versus non-use.

CONCLUSION:

Among those at low baseline stroke risk, people receiving OACs had a lower risk of testing positive for SARS-CoV-2 and severe COVID-19 outcomes than non-users; this might be explained by a causal effect of OACs in preventing severe COVID-19 outcomes or unmeasured confounding, including more cautious behaviours leading to reduced infection risk.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Atrial Fibrillation / Stroke / COVID-19 Type of study: Etiology study / Incidence study / Observational study / Risk factors Topics: Long Covid Limits: Humans Language: English Journal: Br J Gen Pract Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Atrial Fibrillation / Stroke / COVID-19 Type of study: Etiology study / Incidence study / Observational study / Risk factors Topics: Long Covid Limits: Humans Language: English Journal: Br J Gen Pract Year: 2022 Document Type: Article