Abstract
Objective: Altered coagulation parameters in COVID-19 patients is associated with a poor prognosis. We tested whether COVID-19 patients on chronic oral anticoagulants (cOACs) for thromboembolism prophylaxis could receive protection from developing more severe phenotypes of the disease.Approach and Results: We searched the database of the SARS-RAS study (Clinicaltrials.gov: NCT04331574), a cross-sectional observational multicenter nationwide survey in Italy designed by the Italian Society of Hypertension. The database counts 2,377 charts of Italian COVID-19 patients in 26 hospitals. We calculated the Charlson comorbidity index (CCI), which is associated with death in COVID-19 patients. In our population (n = 2,377, age 68.2 ± 0.4 years, CCI: 3.04 ± 0.04), we confirm that CCI is associated with increased mortality [OR: 1.756 (1.628-1.894)], admission to intensive care units [ICU; OR: 1.074 (1.017-1.134)], and combined hard events [CHE; OR: 1.277 (1.215-1.342)]. One hundred twenty-five patients were on cOACs (age: 79.3 ± 0.9 years, CCI: 4.35 ± 0.13); despite the higher CCI, cOACs patients presented with a lower risk of admissions to the ICU [OR 0.469 (0.250-0.880)] but not of death [OR: 1.306 (0.78-2.188)] or CHE [OR: 0.843 (0.541-1.312)]. In multivariable logistic regression, cOACs confirmed their protective effect on ICU admission and CHE. The CCI remains the most important risk factor for ICU admission, death, and CHE.Conclusions: Our data support a mechanism for the continuation of cOAC therapy after hospital admission for those patients who are on chronic treatment. Our preliminary results suggest the prophylactic use of direct cOACs in patients with elevated CCI score at the time of the COVID-19 pandemic even in absence of other risks of thromboembolism.
Highlights
The current epidemic of COVID-19 has put the world population and health care systems under enormous stress, acting as an accelerator for death in the older population and anticipating the failure of hospitalocentric administration of health care in light of the increased request for hospital admissions
The evidence that altered coagulation parameters in COVID-19 patients is associated with poor prognosis [3, 4] and has led us to hypothesize that the virus can cause an endothelial disease with systemic manifestation due to increased thrombosis [5]
Low-molecularweight heparin anticoagulation in the intensive care unit is associated with better prognosis in severe COVID-19 patients [6]
Summary
The current epidemic of COVID-19 has put the world population and health care systems under enormous stress, acting as an accelerator for death in the older population and anticipating the failure of hospitalocentric administration of health care in light of the increased request for hospital admissions. The scientific community has to, identify how to protect the high-risk population from the development of critical conditions that would increase the request for high-intensity care. It is clear from the available literature that older and multimorbid patients are at risk of worse outcomes of COVID-19 [1, 2]. The evidence that altered coagulation parameters in COVID-19 patients is associated with poor prognosis [3, 4] and has led us to hypothesize that the virus can cause an endothelial disease with systemic manifestation due to increased thrombosis [5]. Low-molecularweight heparin anticoagulation in the intensive care unit is associated with better prognosis in severe COVID-19 patients [6]. We explore the possibility that COVID-19 patients on chronic oral anticoagulants (cOACs) for a concomitant condition (i.e., atrial fibrillation, mechanic valvular replacement, pulmonary thromboembolism prophylaxis) before admission receive protection from more severe outcomes
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