Abstract
PurposeThe clinical course of COVID-19 may be complicated by acute respiratory distress syndrome (ARDS) and thromboembolic events, which are associated with high risk of mortality. Although previous studies reported a lower rate of death in patients treated with heparin, the potential benefit of chronic oral anticoagulation therapy (OAT) remains unknown. We aimed to investigate the association between OAT with the risk of ARDS and mortality in hospitalized patients with COVID-19.MethodsThis is a multicenter retrospective Italian study including consecutive patients hospitalized for COVID-19 from March 1 to April 22, 2020, at six Italian hospitals. Patients were divided into two groups according to the chronic assumption of oral anticoagulants.ResultsOverall, 427 patients were included; 87 patients (19%) were in the OAT group. Of them, 54 patients (13%) were on treatment with non-vitamin k oral anticoagulants (NOACs) and 33 (8%) with vitamin-K antagonists (VKAs). OAT patients were older and had a higher rate of hypertension, diabetes, and coronary artery disease compared to No-OAT group. The rate of ARDS at admission (26% vs 28%, P=0.834), or developed during the hospitalization (9% vs 10%, P=0.915), was similar between study groups; in-hospital mortality (22% vs 26%, P=0.395) was also comparable. After balancing for potential confounders by using the propensity score matching technique, no differences were found in term of clinical outcome between OAT and No-OAT patientsConclusionOral anticoagulation therapy, either NOACs or VKAs, did not influence the risk of ARDS or death in patients hospitalized with COVID-19.
Highlights
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) is a novel human coronavirus recently recognized as the cause of the coronavirus disease 2019 (COVID-19)
Distributed variables were expressed as mean ± standard deviation (SD), whereas non-normal distributed ones as median
AF, atrial fibrillation; CAD, coronary artery disease; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; HF, heart failure; non-vitamin k oral anticoagulants (NOACs), non-vitamin K oral anticoagulants; vitamin-K antagonists (VKAs), vitamin K antagonists; VTE, venous thromboembolism; adult respiratory distress syndrome (ARDS), acute respiratory distress syndrome risk of mortality (HR: 1.26, 95% confidence intervals (CI) 0.74–2.1)
Summary
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) is a novel human coronavirus recently recognized as the cause of the coronavirus disease 2019 (COVID-19). Poorly symptomatic in many cases, COVID-19 may be complicated by severe conditions such as adult respiratory distress syndrome (ARDS), sepsis, and death [8]. An increasing number of studies have showed abnormal serum coagulation parameters in hospitalized patients with severe forms of COVID-19 with a trend toward hypercoagulable state [9,10,11,12], and may justify the high prevalence of venous thromboembolism (VTE), disseminated intravascular coagulation (DIC), and ARDS [9, 13,14,15]. The benefit of chronic oral anticoagulation therapy (OAT) on clinical outcome of hospitalized patients with COVID-19 is still debated [20, 21]
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