Pre-medication with oral anticoagulants is associated with better outcomes in a large multinational COVID-19 cohort with cardiovascular comorbidities
Authors:
Marina Rieder, Nadine Gauchel, Klaus Kaier, Carolin Jakob, Stefan Borgmann, Annika Y. Classen, Jochen Schneider, Lukas Eberwein, Martin Lablans, Maria Rüthrich, Sebastian Dolff, Kai Wille, Martina Haselberger, Hanno Heuzeroth, Christoph Bode, Constantin von zur Mühlen, Siegbert Rieg, Daniel Duerschmied
Coagulopathy and venous thromboembolism are common findings in coronavirus disease 2019 (COVID-19) and are associated with poor outcome. Timely initiation of anticoagulation after hospital admission was shown to be beneficial. In this study we aim to examine the association of pre-existing oral anticoagulation (OAC) with outcome among a cohort of SARS-CoV-2 infected patients.
Methods and results
We analysed the data from the large multi-national Lean European Open Survey on SARS-CoV-2 infected patients (LEOSS) from March to August 2020. Patients with SARS-CoV-2 infection were eligible for inclusion. We retrospectively analysed the association of pre-existing OAC with all-cause mortality. Secondary outcome measures included COVID-19-related mortality, recovery and composite endpoints combining death and/or thrombotic event and death and/or bleeding event. We restricted bleeding events to intracerebral bleeding in this analysis to ensure clinical relevance and to limit reporting errors. A total of 1 433 SARS-CoV-2 infected patients were analysed, while 334 patients (23.3%) had an existing premedication with OAC and 1 099 patients (79.7%) had no OAC. After risk adjustment for comorbidities, pre-existing OAC showed a protective influence on the endpoint death (OR 0.62, P = 0.013) as well as the secondary endpoints COVID-19-related death (OR 0.64, P = 0.023) and non-recovery (OR 0.66, P = 0.014). The combined endpoint death or thrombotic event tended to be less frequent in patients on OAC (OR 0.71, P = 0.056).
Conclusions
Pre-existing OAC is protective in COVID-19, irrespective of anticoagulation regime during hospital stay and independent of the stage and course of disease.
Pre-medication with oral anticoagulants is associated with better outcomes in a large multinational COVID-19 cohort with cardiovascular comorbidities
Authors
Marina Rieder Nadine Gauchel Klaus Kaier Carolin Jakob Stefan Borgmann Annika Y. Classen Jochen Schneider Lukas Eberwein Martin Lablans Maria Rüthrich Sebastian Dolff Kai Wille Martina Haselberger Hanno Heuzeroth Christoph Bode Constantin von zur Mühlen Siegbert Rieg Daniel Duerschmied