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. 2024 Feb 6:50:101353.
doi: 10.1016/j.ijcha.2024.101353. eCollection 2024 Feb.

The impacts of prophylactic anticoagulation therapy during hospitalization on long-term cardiovascular outcomes in high-risk COVID-19 patients amid the omicron wave of the pandemic

Jun Gu  1 , Yue Wang  1 , Jun-Feng Zhang  1 , Chang-Qian Wang  1
Affiliations

The impacts of prophylactic anticoagulation therapy during hospitalization on long-term cardiovascular outcomes in high-risk COVID-19 patients amid the omicron wave of the pandemic

Jun Gu et al. Int J Cardiol Heart Vasc. .

Abstract

Background: Although prophylactic anticoagulation therapy is suggested to be adopted in severe COVID-19 patients, its effects on the long-term cardiovascular (CV) outcomes, namely the risk of major adverse CV events(MACEs) in high-risk CV patients amid the omicron wave of the pandemic, remain unknown.

Methods: We conducted this prospective cohort study of consecutive adults hospitalized COVID-19 between 19 April and 12 June 2022, COVID-19 patients with at least two CV risk factors or pre-existing CV diseases were enrolled. A propensity score matching(PSM) method was used to evaluated the effects of prophylactic anticoagulation therapy in hospital on long-term MACEs, including CV death, non-fatal myocardial infarction, non-fatal stroke, hospitalization due to unstable angina pectoris, coronary revascularization and arterial or venous thrombosis.

Results: Two cohorts (with or without anticoagulants during hospitalization) of each 230 patients with balanced baseline characteristics were formed using PSM. During the 15-month follow-up period, 13 patients with anticoagulants and 29 patients without anticoagulants developed MACEs. Overall, the anticoagulation group had a significantly lower risk of MACEs than the control group (hazard ratio [HR] 0.431; 95 % confidence interval [CI]: 0.224-0.830, P = 0.010). Regarding specific constituents of MACEs, the differences were mainly reflected in arterial or venous thrombosis. The significantly lower HRs of overall MACEs were significantly observed in subgroup of age > 75 years, women, higher D dimer level, unvaccinated and non-nirmatrelvir-ritonavir prescribed patients.

Conclusions: Prophylactic anticoagulation therapy during hospitalization was effective in reducing long-term MACEs among COVID-19 patients with CV risk factors or pre-existing CV diseases amid the omicron wave of the pandemic.

Keywords: Anticoagulation therapy; COVID-19; Major adverse cardiovascular events; Omicron variant.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Forest plot of multivariate Cox regression analysis. CRP: C-reactive protein; TNI: troponin I.
Fig. 2
Fig. 2
Survival Kaplan–Meier curve for MACEs, according to the presence or absence of anticoagulation therapy during the index hospitalization for COVID-19.
Supplementary figure 1
Supplementary figure 1
Figrue S1 Flowchart of patient enrollment and cohort construction.
Supplementary figure 2
Supplementary figure 2
Figure S2 Survival Kaplan–Meier curve for MACEs, according to age stratification.
Supplementary figure 3
Supplementary figure 3
Figure S3 Survival Kaplan–Meier curve for MACEs, according to gender difference.
Supplementary figure 4
Supplementary figure 4
Figure S4 Survival Kaplan–Meier curve for MACEs, according to D dimer level.
Supplementary figure 5
Supplementary figure 5
Figure S5 Survival Kaplan–Meier curve for MACEs, according to vaccination condition.
Supplementary figure 6
Supplementary figure 6
Figure S6 Survival Kaplan–Meier curve for MACEs, according to nirmatrelvir–ritonavir prescription.
See this image and copyright information in PMC

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