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. 2021 Mar;289(3):411-419.
doi: 10.1111/joim.13205. Epub 2020 Dec 19.

Direct oral anticoagulant use and risk of severe COVID-19

B Flam  1   2 , V Wintzell  3 , J F Ludvigsson  4   5   6   7 , J Mårtensson  1   2 , B Pasternak  3   8
Affiliations

Direct oral anticoagulant use and risk of severe COVID-19

B Flam et al. J Intern Med. 2021 Mar.

Abstract

Background: Hypercoagulability and thromboembolism are prominent features of severe COVID-19, and ongoing anticoagulant use might be protective.

Methods: We conducted a nationwide register-based cohort study in Sweden, February through May, 2020, to assess whether ongoing direct oral anticoagulant (DOAC) use was associated with reduced risk of hospital admission for laboratory-confirmed COVID-19, or a composite of intensive care unit (ICU) admission or death due to laboratory-confirmed COVID-19.

Results: DOAC use (n = 103 703) was not associated with reduced risk of hospital admission for COVID-19 (adjusted hazard ratio [aHR] [95% confidence interval] 1.00 [0.75-1.33] vs. nonuse atrial fibrillation comparator [n = 36 875]; and aHR 0.94 [0.80-1.10] vs. nonuse cardiovascular disease comparator [n = 355 699]), or ICU admission or death due to COVID-19 (aHRs 0.76 [0.51-1.12], and 0.90 [0.71-1.15], respectively).

Conclusion: Ongoing DOAC use was not associated with reduced risk of severe COVID-19, indicating that prognosis would not be modified by early outpatient DOAC initiation.

Keywords: COVID-19; SARS-CoV-2; anticoagulants; atrial fibrillation; direct-acting oral anticoagulants.

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Conflict of interest statement

Dr. Ludvigsson coordinates a study on behalf of the Swedish Inflammatory Bowel Disease Register (SWIBREG). This study has received funding from Janssen Corporation. The remaining authors declare no competing financial interests.

Figures

Fig. 1
Fig. 1
Cohort construction flow chart. AF, atrial fibrillation; DOAC, direct oral anticoagulant. a Numbers of excluded patients do not accumulate to the total sum, since some patients were excluded for more than one reason.
See this image and copyright information in PMC

Comment in

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