Preexisting Oral Anticoagulant Therapy Ameliorates Prognosis in Hospitalized COVID-19 Patients

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.

Keywords: COVID-19 outcomes; atrial fibrillation; death; hypertension; intensive care admissions; multimorbidity; prophylaxis; thrombosys.

Figure 1

(A) COVID-19 patients were grouped by age decades to show the impact of the disease according to age. Patient numbers increased by age decades. (B) Women were stably below 40% of total cases up to the age of 80 years. (C) Death rates increased with age. (D) ICU admissions were stable along all ages. (E) cOACs were administered increasingly with age. (F) The percentage of patients on cOACs increased with age.

Figure 2

(A) Death rates in non-cOACs and cOACs COVID-19 patients. (B) ICU admission rates were lower in non-cOACs than cOACs COVID-19 patients. (C) CHE (death and ICU admission) rates were similar in non-cOACs and cOACs COVID-19 patients.

Figure 3

(A) Odds ratio and confidence intervals for admission to intensive care units; cOACs: T = −0.825, p < 0.01; CCI: T = 0.085, p < 0.003; male sex: T = 0.602; p < 0.001. (B) Odds ratio and confidence intervals for deaths; CCI: T = 0.567, p < 0.001. (C) Odds ratio and confidence intervals for combined hard events (deaths and ICU admissions); cOACs: T = −0.455; p < 0.05; male sex: T = 0.527; p < 0.001; CCI:T = 0.257; p < 0.001. CCI, Charlson comorbidity index; cOACs, chronic oral anticoagulants; ICU, intensive care units.