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Direct oral anticoagulant use and risk of severe COVID-19

B Flam1,2, V Wintzell3, J F Ludvigsson4,5,6,7

  • 1From the, Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.

Journal of Internal Medicine
|December 1, 2020
PubMed

Insights

Direct oral anticoagulants (DOACs) did not reduce the risk of severe COVID-19. This study found no significant association between DOAC use and reduced hospital admission or intensive care unit admission or death in COVID-19 patients.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Pharmacology

Background:

  • Severe COVID-19 is characterized by hypercoagulability and thromboembolism.
  • Anticoagulant therapy is being investigated for potential protective effects.

Purpose of the Study:

  • To assess if direct oral anticoagulant (DOAC) use reduces the risk of hospital admission for COVID-19.
  • To evaluate if DOAC use lowers the risk of ICU admission or death in COVID-19 patients.

Main Methods:

  • Nationwide register-based cohort study in Sweden (February-May 2020).
  • Compared outcomes for patients on DOACs versus non-users with atrial fibrillation or cardiovascular disease.
  • Assessed hospital admission, ICU admission, and death due to laboratory-confirmed COVID-19.

Main Results:

  • DOAC use was not associated with a reduced risk of hospital admission for COVID-19.
  • No significant association was found between DOAC use and reduced risk of ICU admission or death from COVID-19.
  • Adjusted hazard ratios for hospital admission were 1.00 and 0.94 compared to non-users.

Conclusions:

  • Ongoing direct oral anticoagulant use was not linked to a decreased risk of severe COVID-19.
  • Early outpatient initiation of DOACs is unlikely to modify COVID-19 prognosis.
Abstract

Keywords:
COVID-19SARS-CoV-2anticoagulantsatrial fibrillationdirect-acting oral anticoagulants

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