Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep:205:1-7.
doi: 10.1016/j.thromres.2021.06.014. Epub 2021 Jun 27.

Direct-acting oral anticoagulants use prior to COVID-19 diagnosis and associations with 30-day clinical outcomes

José Miguel Rivera-Caravaca  1 , Benjamin J R Buckley  2 , Stephanie L Harrison  2 , Elnara Fazio-Eynullayeva  3 , Paula Underhill  4 , Francisco Marín  5 , Gregory Y H Lip  6
Affiliations

Direct-acting oral anticoagulants use prior to COVID-19 diagnosis and associations with 30-day clinical outcomes

José Miguel Rivera-Caravaca et al. Thromb Res. 2021 Sep.

Abstract

Background: It is unclear if direct-acting oral anticoagulants (DOACs) use before hospitalization due to COVID-19 diagnosis would potentially impact the severity and clinical outcomes thereafter. We compared 30-day hospitalization/re-hospitalization and clinical outcomes between patients on chronic DOAC therapy and patients not on oral anticoagulation (OAC) therapy at time of COVID-19 diagnosis.

Methods: We used data from TriNetX, a global federated health research network. Patients aged ≥18 years who were treated with DOACs at time of COVID-19 diagnosis between 20 January 2020 and 28 February 2021 were included, and matched with patients not on OAC therapy from the same period. All patients were followed-up at 30-days after COVID-19 diagnosis. The primary outcomes were all-cause mortality, hospitalization/re-hospitalization, venous thromboembolism (VTE) and intracranial hemorrhage (ICH).

Results: 738,423 patients were included. After propensity score matching (PSM), 26,006 patients remained in the study (13,003 on DOACs; 13,003 not on OAC). DOAC-treated patients (mean age 67.1 ± 15.4 years, 52.2% male) had higher relative risks (RRs) and lower 30-days event-free survival as compared to patients not on OAC for all-cause mortality (RR 1.27, 95% CI 1.12-1.44; Log-Rank test p = 0.010), hospitalization/re-hospitalization (RR 1.72, 95% CI 1.64-1.82; Log-Rank test p < 0.001) and VTE (RR 4.51, 95% CI 3.91-5.82; Log-Rank test p < 0.001), but not for ICH (RR 0.90, 95% CI 0.54-1.51; Log-Rank test p = 0.513).

Conclusion: In COVID-19 patients, previous DOAC therapy at time of diagnosis was not associated with improved clinical outcomes or lower hospitalization/re-hospitalization rate compared to patients not taking OAC therapy.

Keywords: Anticoagulant; Bleeding; Coronavirus disease 2019; Direct-acting oral anticoagulants; Mortality; SARS-CoV-2; Thrombosis.

PubMed Disclaimer

Conflict of interest statement

JMR-C has received a grant from Sociedad Española de Trombosis y Hemostasia (grant for short international training stays 2020), and the First Contact Initiative Grant 2020 from the European Society of Cardiology Council on Basic Cardiovascular Science. GYHL: Consultant and speaker for BMS/Pfizer, Boehringer Ingelheim and Daiichi-Sankyo. No fees are received personally. Other authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
Forest plot of odds ratios for outcomes in the DOAC population after propensity score matching. TIA = transient ischemic attack; SE = systemic embolism; ICH = intracranial hemorrhage.
Fig. 2
Fig. 2
Comparison of survival curves for the primary outcomes between patients on DOACs or not at COVID-19 diagnosis after propensity score matching. Purple line = Prior DOAC use. Green line = Not prior OAC use. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
See this image and copyright information in PMC

References

    1. Wu Z., JM McGoogan. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a Report of 72&nbsp;314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239–1242. - PubMed
    1. Bikdeli B., Madhavan M.V., Jimenez D., Chuich T., Dreyfus I., Driggin E., et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up. J. Am. Coll. Cardiol. 2020;75(23):2950–2973. - PMC - PubMed
    1. Violi F., Pastori D., Cangemi R., Pignatelli P., Loffredo L. Hypercoagulation and antithrombotic treatment in coronavirus 2019: a new challenge. Thromb. Haemost. 2020;120(6):949–956. - PMC - PubMed
    1. Del Sole F., Farcomeni A., Loffredo L., Carnevale R., Menichelli D., Vicario T., et al. Features of severe COVID-19: a systematic review and meta-analysis. Eur. J. Clin. Investig. 2020;50(10) - PMC - PubMed
    1. Piazza G., Campia U., Hurwitz S., Snyder J.E., Rizzo S.M., Pfeferman M.B., et al. Registry of arterial and venous thromboembolic complications in patients with COVID-19. J. Am. Coll. Cardiol. 2020;76(18):2060–2072. - PMC - PubMed