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Association between oral anticoagulants and COVID-19 related outcomes: two cohort studies (preprint)
medrxiv; 2021.
Preprint
Dans Anglais
| medRxiv | ID: ppzbmed-10.1101.2021.04.30.21256119
ABSTRACT
Objectives:
We investigated the role of routinely prescribed oral anticoagulants (OACs) in COVID-19 outcomes, comparing current OAC use versus non-use in Study 1; and warfarin versus direct oral anticoagulants (DOACs) in Study 2.Design:
Two cohort studies, on behalf of NHS England.Setting:
Primary care data and pseudonymously-linked SARS-CoV-2 antigen testing data, hospital admissions, and death records from England.Participants:
Study 1 70,464 people with atrial fibrillation (AF) and CHA2DS2-VASc score of 2. Study 2 372,746 people with non-valvular AF. Main outcomemeasures:
Time to test for SARS-CoV-2, testing positive for SARS-CoV-2, COVID-19 related hospital admission, COVID-19 deaths or non-COVID-19 deaths in Cox regression.Results:
In Study 1, we included 52,416 current OAC users and 18,048 non-users. We observed no difference in risk of being tested for SARS-CoV-2 associated with current use (adjusted HR, 1.01, 95%CI, 0.96 to 1.05) versus non-use. We observed a lower risk of testing positive for SARS-CoV-2 (adjusted HR, 0.73, 95%CI, 0.60 to 0.90), and COVID-19 deaths (adjusted HR, 0.69, 95%CI, 0.49 to 0.97) associated with current use versus non-use. In Study 2, we included 92,339 warfarin users and 280,407 DOAC users. We observed a lower risk of COVID-19 deaths (adjusted HR, 0.79, 95%CI, 0.76 to 0.83) associated with warfarin versus DOACs. Similar associations were found for all other outcomes.Conclusions:
Among people with AF and a CHA2DS2-VASc score of 2, those receiving OACs had a lower risk of receiving a positive COVID-19 test 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 more cautious behaviours leading to reduced infection risk. There was no evidence of a higher risk of severe COVID-19 outcomes associated with warfarin versus DOACs in people with non-valvular AF regardless of CHA2DS2-VASc score.
Texte intégral:
Disponible
Collection:
Preprints
Base de données:
medRxiv
Sujet Principal:
Fibrillation auriculaire
/
Mort
/
COVID-19
langue:
Anglais
Année:
2021
Type de document:
Preprint
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