Treatment with oral anticoagulants and risk of mortality in COVID-19 patients

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<b>Background:</b> Venous thromboembolia have been reported in patients with COVID-19. However, it remains unclear if COVID-19 patients who, for other indications, take anti-coagulant medication on a regular basis, are protected against thrombosis-mediated death. The aim of this study was to estimate the risk of all-cause mortality, hospital admission, and intensive care unit (ICU) admission for verified COVID-19 patients who did vs. did not use oral anticoagulant therapy (OAC). <b>Methods:</b> Data was obtained by using national registries. Patients were followed for 90 days or until death or hospital admission. An adjusted Cox proportional hazard regression was used to estimate the risk of all-cause mortality, hospital admission and ICU admission. <b>Results:</b> A total of 243,039 confirmed COVID-19 patients were included in the study (mean age 35 years; 123,448 [50.79%] male), among whom 4,482 were OAC users. We observed an increased risk of all-cause mortality (HR 1.12, 95% CI 1.011-1.24, p=0.015) and hospital admission (HR 1.22, 95% CI 1.13-1.31, p&lt;0.0001) in OAC users. Among admitted patients, however, we observed a decreased risk of ICU admission (HR 0.78, 95% CI 0.63-0.96, p=0.02) in OAC users. <b>Conclusion:</b> OAC was not associated with a lower risk of death or hospital admission, but our data support that hospitalized patients without anticoagulant treatment, may be at increased risk of respiratory deterioration and need for intensive care admission.