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Clinical profile and prognosis in patients on oral anticoagulation before admission for COVID-19
José Miguel Rivera-Caravaca1, Iván J Núñez-Gil2, David Vivas2
1Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain.
Insights
Patients on oral anticoagulation (OAC) therapy admitted for COVID-19 had higher mortality risk. Respiratory insufficiency, systemic inflammatory response syndrome (SIRS), and comorbidities were key risk factors for death in these patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) presents significant mortality risks, especially for individuals with pre-existing cardiovascular conditions.
- A subset of COVID-19 patients are on oral anticoagulation (OAC) therapy, but their clinical characteristics and prognosis during hospitalization remain understudied.
Purpose of the Study:
- To investigate the clinical profile, prognosis, and mortality risk factors of COVID-19 patients on OAC therapy at hospital admission.
- To compare the outcomes of COVID-19 patients on OAC versus those not on OAC.
Main Methods:
- Subanalysis of the international HOPE COVID-19 registry, including patients on OAC at hospital admission for COVID-19.
- Propensity score matching and multivariate Cox regression analysis to assess mortality and identify risk factors.
Main Results:
- 110 patients on OAC were included; 67.9% died during hospitalization, a significantly higher rate than patients without prior OAC (HR 1.53).
- Key mortality risk factors in OAC patients included respiratory insufficiency (HR 6.02), systemic inflammatory response syndrome (SIRS) (HR 2.29), and higher comorbidity burden (Short-Form CCI, HR 1.24).
Conclusions:
- COVID-19 patients on OAC therapy at admission face lower survival and increased mortality risk compared to non-OAC patients.
- High comorbidity prevalence is noted in OAC patients. Respiratory insufficiency, SIRS, and comorbidity burden identify OAC patients at higher risk of mortality.
Background:
The coronavirus disease 2019 (COVID-19) shows high morbidity and mortality, particularly in patients with concomitant cardiovascular diseases. Some of these patients are under oral anticoagulation (OAC) at admission, but to date, there are no data on the clinical profile, prognosis and risk factors of such patients during hospitalization for COVID-19.
Design:
Subanalysis of the international 'real-world' HOPE COVID-19 registry. All patients with prior OAC at hospital admission for COVID-19 were suitable for the study. All-cause mortality was the primary endpoint.
Results:
From 1002 patients included, 110 (60.9% male, median age of 81.5 [IQR 75-87] years, median Short-Form Charlson Comorbidity Index [CCI] of 1 [IQR 1-3]) were on OAC at admission, mainly for atrial fibrillation and venous thromboembolism. After propensity score matching, 67.9% of these patients died during hospitalization, which translated into a significantly higher mortality risk compared to patients without prior OAC (HR 1.53, 95% CI 1.08-2.16). After multivariate Cox regression analysis, respiratory insufficiency during hospitalization (HR 6.02, 95% CI 2.18-16.62), systemic inflammatory response syndrome (SIRS) during hospitalization (HR 2.29, 95% CI 1.34-3.91) and the Short-Form CCI (HR 1.24, 95% CI 1.03-1.49) were the main risk factors for mortality in patients on prior OAC.
Conclusions:
Compared to patients without prior OAC, COVID-19 patients on OAC therapy at hospital admission showed lower survival and higher mortality risk. In these patients on OAC therapy, the prevalence of several comorbidities is high. Respiratory insufficiency and SIRS during hospitalization, as well as higher comorbidity, pointed out those anticoagulated patients with increased mortality risk.
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