Abstract
BackgroundIt remains uncertain if prior use of oral anticoagulants (OACs) in COVID-19 outpatients with multimorbidity impacts prognosis, especially if cardiometabolic diseases are present. Clinical outcomes 30-days after COVID-19 diagnosis were compared between outpatients with cardiometabolic disease receiving vitamin K antagonist (VKA) or direct-acting OAC (DOAC) therapy at time of COVID-19 diagnosis.MethodsA study was conducted using TriNetX, a global federated health research network. Adult outpatients with cardiometabolic disease (i.e. diabetes mellitus and any disease of the circulatory system) treated with VKAs or DOACs at time of COVID-19 diagnosis between 20-Jan-2020 and 15-Feb-2021 were included. Propensity score matching (PSM) was used to balance cohorts receiving VKAs and DOACs. The primary outcomes were all-cause mortality, intensive care unit (ICU) admission/mechanical ventilation (MV) necessity, intracranial haemorrhage (ICH)/gastrointestinal bleeding, and the composite of any arterial or venous thrombotic event(s) at 30-days after COVID-19 diagnosis.Results2275 patients were included. After PSM, 1270 patients remained in the study (635 on VKAs; 635 on DOACs). VKA-treated patients had similar risks and 30-day event-free survival than patients on DOACs regarding all-cause mortality, ICU admission/MV necessity, and ICH/gastrointestinal bleeding. The risk of any arterial or venous thrombotic event was 43% higher in the VKA cohort (hazard ratio 1.43, 95% confidence interval 1.03–1.98; Log-Rank test p = 0.029).ConclusionIn COVID-19 outpatients with cardiometabolic diseases, prior use of DOAC therapy compared to VKA therapy at the time of COVID-19 diagnosis demonstrated lower risk of arterial or venous thrombotic outcomes, without increasing the risk of bleeding.
Highlights
Oral anticoagulants (OACs), including vitamin K antagonists (VKAs) and direct-acting oral anticoagulants (OACs) (DOACs), have been used for thromboprophylaxis in different clinical scenarios
These trials evidences are supported by data from real world and observational studies, where direct-acting OAC (DOAC) have demonstrated significantly lower rates for major bleeding and a positive net clinical benefit compared to VKAs [10,11,12,13]
There were no differences between cohorts regarding the main reasons for OAC (i.e. atrial fibrillation (AF) or previous pulmonary embolism)
Summary
Oral anticoagulants (OACs), including vitamin K antagonists (VKAs) and direct-acting OACs (DOACs), have been used for thromboprophylaxis in different clinical scenarios. In venous thromboembolism (VTE), dabigatran, rivaroxaban, apixaban and edoxaban were non-inferior to conventional therapy in terms of efficacy and caused less bleeding in a broad spectrum of patients [5,6,7,8,9] These trials evidences are supported by data from real world and observational studies, where DOACs have demonstrated significantly lower rates for major bleeding and a positive net clinical benefit compared to VKAs [10,11,12,13]. A common limitation is that most of the evidence to date refers to the hospitalization context It remains uncertain if prior OAC therapy in outpatients, especially amongst patients with multimorbidity, would potentially influence the severity and clinical outcomes after COVID-19 diagnosis. Clinical outcomes 30-days after COVID-19 diagnosis were compared between outpatients with cardiometabolic disease receiving vitamin K antagonist (VKA) or direct-acting OAC (DOAC) therapy at time of COVID-19 diagnosis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
