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. 2022 Jun 30;72(720):e456-e463.
doi: 10.3399/BJGP.2021.0689. Print 2022 Jul.

Association between oral anticoagulants and COVID-19-related outcomes: a population-based cohort study

Angel Ys Wong  1 , Laurie Tomlinson  1 , Jeremy P Brown  1 , William Elson  1 , Alex J Walker  2 , Anna Schultze  1 , Caroline E Morton  2 , David Evans  2 , Peter Inglesby  2 , Brian MacKenna  2 , Krishnan Bhaskaran  1 , Christopher T Rentsch  1 , Emma Powell  1 , Elizabeth Williamson  1 , Richard Croker  2 , Seb Bacon  2 , William Hulme  2 , Chris Bates  3 , Helen J Curtis  2 , Amir Mehrkar  2 , Jonathan Cockburn  3 , Helen I McDonald  4 , Rohini Mathur  1 , Kevin Wing  1 , Harriet Forbes  5 , Rosalind M Eggo  1 , Stephen Jw Evans  1 , Liam Smeeth  4 , Ben Goldacre  2 , Ian J Douglas  1 ; (The OpenSAFELY Collaborative)
Affiliations

Association between oral anticoagulants and COVID-19-related outcomes: a population-based cohort study

Angel Ys Wong et al. Br J Gen Pract. .

Abstract

Background: Early evidence has shown that anticoagulant reduces the risk of thrombotic events in those infected with COVID-19. However, evidence of the role of routinely prescribed oral anticoagulants (OACs) in COVID-19 outcomes is limited.

Aim: To investigate the association between OACs and COVID-19 outcomes in those with atrial fibrillation and a CHA2DS2-VASc score of 2.

Design and setting: On behalf of NHS England, a population-based cohort study was conducted.

Method: The study used primary care data and pseudonymously-linked SARS-CoV-2 antigen testing data, hospital admissions, and death records from England. Cox regression was used to estimate hazard ratios (HRs) for COVID-19 outcomes comparing people with current OAC use versus non-use, accounting for age, sex, comorbidities, other medications, deprivation, and general practice.

Results: Of 71 103 people with atrial fibrillation and a CHA2DS2-VASc score of 2, there were 52 832 current OAC users and 18 271 non-users. No difference in risk of being tested for SARS-CoV-2 was associated with current use (adjusted HR [aHR] 0.99, 95% confidence interval [CI] = 0.95 to 1.04) versus non-use. A lower risk of testing positive for SARS-CoV-2 (aHR 0.77, 95% CI = 0.63 to 0.95) and a marginally lower risk of COVID-19-related death (aHR, 0.74, 95% CI = 0.53 to 1.04) were associated with current use versus non-use.

Conclusion: Among those at low baseline stroke risk, people receiving OACs had a lower risk of testing positive for SARS-CoV-2 and severe COVID-19 outcomes than non-users; this might be explained by a causal effect of OACs in preventing severe COVID-19 outcomes or unmeasured confounding, including more cautious behaviours leading to reduced infection risk.

Keywords: COVID-19; Factor Xa Inhibitors; dabigatran; warfarin.

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Figures

Figure 1.
Figure 1.
Study diagram, illustrating the follow-up from 1 March 2020 to the latest at death, outcome occurrence, deregistration from TPP (TPP SystmOne software practice), or 28 September 2020 and identification of covariates before 1 March 2020. Date in brackets shows the range of the time window (days in unit). A&E = accident & emergency. EFU = end of followup. OAC = oral coagulation. TIA = transient ischaemic attack.
Figure 2.
Figure 2.
Flow chart of inclusion of participants. IMD = Index of Multiple Deprivation. TPP = TPP SystmOne software practice.
Figure 3.
Figure 3.
Hazard ratios of the association between current use of oral anticoagulants and COVID-19-related outcomes versus non-use in people with atrial fibrillation who had a CHA2DS2-VASc score of 2. CI = confidence interval. DAG = directed acyclic graph.
See this image and copyright information in PMC

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