Pre-arrest oral anticoagulants' impact on cardiac arrest mortality: MIMIC-IV cohort retrospect

The impact of oral anticoagulant use prior to cardiac arrest (CA) on short-term and long-term all-cause mortality remains largely unknown. This study aimed to explore the association between pre-arrest oral anticoagulant use and both immediate and extended survival outcomes following CA.

We identified 1,203 adult CA patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV V3.1) database, grouped by prior oral anticoagulant use. Propensity score matching (PSM) was conducted to minimize confounding effects. Adjusted Cox proportional hazards models were applied to account for pre-hospital and hospitalization factors.

Patients in the anticoagulant group demonstrated a significantly higher 28-day survival rate [hazard ratio (HR) 0.28; 95% confidence interval (CI) 0.22-0.37; P < 0.001]. After PSM, 120 patients were assigned to the anticoagulant group and 130 to the non-anticoagulant group. In the matched cohort, patients in the anticoagulant group continued to demonstrate improved 28-day survival compared to the non-anticoagulant group (HR 0.40; 95% CI 0.27-0.60; P < 0.001). Consistent survival benefits were observed at 90, 180, and 365 days. Subgroup analyses further supported these findings.

Pre-arrest oral anticoagulant use may be associated with improved survival outcomes in CA patients.