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Published on: February 26, 2013
Chronic Anticoagulation in Patients with Atrial Fibrillation and COVID-19: A Systematic Review and Meta-Analysis
Isabela Landsteiner1, Jonathan A Pinheiro2, Nicole Felix3
1Massachusetts General Hospital, Boston, Massachusetts - EUA.
Insights
For atrial fibrillation (AF) patients with COVID-19, continuing anticoagulation therapy significantly lowered the risk of death from any cause and COVID-19 specifically. This finding supports ongoing anticoagulation in this vulnerable patient group.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Coronavirus disease 2019 (COVID-19) is linked to increased blood clot risk (hypercoagulability).
- The benefit of continuing anticoagulation for atrial fibrillation (AF) in COVID-19 patients is not well-established.
Purpose of the Study:
- To evaluate if chronic anticoagulation for AF impacts outcomes in patients who contract COVID-19.
- Key outcomes assessed include all-cause mortality, COVID-19 mortality, ICU admission, and hospitalization.
Main Methods:
- A systematic literature search was conducted across PubMed, Embase, and Cochrane Library up to December 2022.
- Meta-analysis of 10 studies involving over 1.1 million patients compared COVID-19 outcomes in AF patients with and without prior anticoagulation.
- Risk ratios and confidence intervals were pooled using a random-effects model.
Main Results:
- Chronic anticoagulation in COVID-19 patients with AF was associated with a significant reduction in all-cause mortality (RR 0.75; p=0.048) and COVID-19 mortality (RR 0.76; p<0.001).
- No significant difference was observed in hospitalization rates (RR 1.08; p=0.587) or ICU admissions (RR 0.86; p=0.216).
Conclusions:
- Continuing anticoagulation for AF patients who develop COVID-19 is linked to substantially lower mortality rates.
- The findings suggest a protective effect of anticoagulation against fatal outcomes in this patient population.
Background:
Coronavirus disease 2019 (COVID-19) is associated with hypercoagulability. It remains uncertain whether ongoing anticoagulation for atrial fibrillation (AF) in patients who later contract COVID-19 improves clinical outcomes.
Objectives:
To compare chronic oral anticoagulation with no previous anticoagulation in patients with AF who contracted a COVID-19 infection concerning the outcomes of all-cause mortality, COVID-19 mortality, intensive care unit (ICU) admission, and hospitalization.
Methods:
We systematically searched PubMed, Embase, and Cochrane Library for eligible studies from inception to December 2022. We included studies comparing COVID-19 outcomes in patients with versus without prior chronic anticoagulation for AF. Risk ratios (RR) with 95% confidence intervals (CI) were pooled with a random-effects model. The level of significance was set at p < 0.05. Quality assessment and risk of bias were performed according to Cochrane recommendations.
Results:
Ten studies comprising 1,177,858 patients with COVID-19 and AF were identified, of whom 893,772 (75.9%) were on prior chronic anticoagulation for AF. In patients with COVID-19, being on chronic anticoagulation for AF significantly reduced all-cause mortality (RR 0.75; 95% CI 0.57 to 0.99; p = 0.048; I2 = 89%) and COVID-19-related mortality (RR 0.76; 95% CI 0.72 to 0.79; p < 0.001; I2 = 0%) when compared with no prior anticoagulation. In contrast, there was no difference between groups regarding hospitalization (RR 1.08; 95% CI 0.82 to 1.41; p = 0.587; I2 = 95%) or ICU admission (RR 0.86; 95% CI 0.68 to 1.09; p = 0.216; I2 = 69%).
Conclusions:
In this meta-analysis, chronic anticoagulation for patients with AF who contracted COVID-19 was associated with significantly lower rates of all-cause mortality and COVID-19-related mortality as compared with no previous anticoagulation.
