Does chronic oral anticoagulation reduce in-hospital mortality among COVID-19 older patients?

Abstract

Background: Patients hospitalized with COVID-19 experienced an increased risk of venous thromboembolism.

Aims: To evaluate the effect of chronic oral anticoagulation (OAC) therapy, both with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs), on prognosis of COVID-19 older patients.

Methods: Single-center prospective study conducted in the Emergency Department (ED) of a teaching hospital, referral center for COVID-19 in central Italy. We evaluated all the patients ≥ 65 years, consecutively admitted to our ED for confirmed COVID-19. We compared the clinical outcome of those who were on chronic OAC at ED admission with those who did not, using a propensity score matched paired cohort of controls. The primary study endpoint was all-cause in-hospital death. Patients were matched for age, sex, clinical comorbidities, and clinical severity at presentation (based on NEWS ≥ 6). Study parameters were assessed for association to all-cause in-hospital death by a multivariate Cox regression analysis to identify independent risk factor for survival.

Results: Although overall mortality was slightly higher for anticoagulated patients compared to controls (63.3% vs 43.5%, p = 0.012), the multivariate adjusted hazard ratio (HR) for death was not significant (HR = 1.56 [0.78-3.12]; p = 0.208). Both DOACs (HR 1.46 [0.73-2.92]; p = 0.283) and VKAs (HR 1.14 [0.48-2.73]; p = 0.761) alone did not affect overall survival in our cohort.

Conclusions: Among older patients hospitalized for COVID-19, chronic OAC therapy was not associated with a reduced risk of in-hospital death. Moreover, our data suggest similar outcome both for patients on VKAs or in patients on DOACs.

Keywords: COVID-19; Direct oral anticoagulants; Older patients; Oral anticoagulation; Vitamin k antagonists.

Fig. 1

Cumulative survival rate in anticoagulated patients vs controls. Once corrected for clinical and demographic characteristics at admission death risk was similar for anticoagulated and controls (anticoagulation HR = 1.56 [0.78–3.12]; p = 0.208)