Abstract
BackgroundEarly 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.AimTo investigate the association between OACs and COVID-19 outcomes in those with atrial fibrillation and a CHA2DS2-VASc score of 2.Design and settingOn behalf of NHS England, a population-based cohort study was conducted.MethodThe 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.ResultsOf 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.ConclusionAmong 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.
Highlights
Studies reported that heparin lowers the risk of pulmonary embolism and mortality during hospitalisation among patients with COVID-191–4
We observed a lower risk of testing positive for SARS-CoV-2, and marginally lower risk of COVID-19 deaths associated with current use versus non-use. ript Conclusions: Among those at low baseline stroke risk, people receiving OACs had a lower sc risk of testing positive for SARS-CoV-2 and severe COVID-19 outcomes than non-users; this nu might be explained by a causal effect of OACs in preventing severe COVID-19 outcomes or a unmeasured confounding including more cautious behaviours leading to reduced infection M risk. ted Keywords: oral anticoagulants, warfarin, direct oral anticoagulants, COVID-19 Accep 1
Understanding the effects of routinely prescribed OACs 02 on COVID-19 can be of significant clinical importance that further informs OAC prescribing .2 guidance in the context of COVID-19 pandemic, given that atrial fibrillation (AF) may have a prognostic role in P COVID-19 disease[7]
Summary
Studies reported that heparin lowers the risk of pulmonary embolism and mortality during hospitalisation among patients with COVID-191–4. 89 anticoagulation, it remains uncertain whether there is a role of routinely prescribed OACs for .06 atrial fibrillation (AF) on COVID-19 outcomes. The use of CHA2DS2-VASc score is to M determine the need for prescribed anticoagulants in people with non-valvular atrial fibrillation ted as a prophylactic therapy against stroke. According to the guidelines for the management of Accep 2 patients with AF20–22, people with a CHA2DS2-VASc score of ≥2 should be offered an anticoagulant For those with a score of 2, there is possibly a degree of variation in OAC prescribing, offering a useful group in whom OAC users are likely to be more comparable with non-users to minimise confounding. A UK study showed that patients with a CHA2DS2-VASc score of 2 were more likely to remain untreated with anticoagulants than patients with a score ≥3.6 A better understanding of the impact of OACs on COVID. Evidence of the role of routinely prescribed oral anticoagulants (OACs) in COVID-19 outcomes is limited
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