Management and impact of atrial fibrillation in the COVID 19 era; concomitancy of two procoagulant phenomena

Abstract

Abstract Background Atrial fibrillation (AF) is a widespread cause of prothrombotic state leading to long-term anticoagulant therapy. Literature describes coagulopathy as a key pathogenic mechanism of COVID-19 disease. Thus, antithrombotic therapy management is still a therapeutic challenge. During hospitalization, changing oral anticoagulant (OAC) therapies into subcutaneous heparin is common in daily clinical practice. Purpose The primary endpoint of this study is to analyze the impact of AF in mortality within 30 day since admission of COVID-19 patients. The secondary endpoint is to analyze the impact of the anticoagulant therapy strategy (therapeutic dose of subcutaneous heparin vs. OAC) in 30-day mortality of hospitalized COVID-19 patients with AF. Methods A total of 1001 consecutive patients hospitalized in our centre between 22nd August and 9th January 2021 with a confirmed microbiological diagnosis of COVID-19 by PCR were prospectively included. Of them, 134 had a previous diagnose of AF (13.5%). Cox regression analysis was performed to assess the impact of AF and the choice of anticoagulant therapy in 30-day mortality after adjusting for comorbidity (Charlson Comorbidity Index). Results After adjusting for comorbidities, AF was not independently associated with a higher 30-day mortality in patients hospitalized due to COVID-19 infection (HR 1.04, CI 0.77–1.43, p=0.760). In the group of patients with AF, changing OAC to heparin therapy was not associated with an improved prognosis (HR 0.85, CI 95% 0.46–1.56, p=0.604). Conclusions AF is not an independent prognostic factor in COVID-19 hospitalized patients. In hospitalized COVID-19 patients with AF, changing OAC to heparin therapy is not related to an improved prognosis. Funding Acknowledgement Type of funding sources: None. Mortality heparin vs NOAC or AVK