Efficacy and safety of direct-acting oral anticoagulants compared to vitamin K antagonists in COVID-19 outpatients with cardiometabolic diseases

Rivera-Caravaca, Jose Miguel ORCID: 0000-0003-0492-6241, Harrison, Stephanie L ORCID: 0000-0002-8846-0946, Buckley, Benjamin JR ORCID: 0000-0002-1479-8872, Fazio-Eynullayeva, Elnara, Underhill, Paula, Marin, Francisco and Lip, Gregory YH ORCID: 0000-0002-7566-1626 (2021) Efficacy and safety of direct-acting oral anticoagulants compared to vitamin K antagonists in COVID-19 outpatients with cardiometabolic diseases. CARDIOVASCULAR DIABETOLOGY, 20 (1). 176-.

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Official URL: http://dx.doi.org/10.1186/s12933-021-01368-6

Abstract

<h4>Background</h4>It remains uncertain if prior use of oral anticoagulants (OACs) in COVID-19 outpatients with multimorbidity impacts prognosis, especially if cardiometabolic diseases are present. Clinical outcomes 30-days after COVID-19 diagnosis were compared between outpatients with cardiometabolic disease receiving vitamin K antagonist (VKA) or direct-acting OAC (DOAC) therapy at time of COVID-19 diagnosis.<h4>Methods</h4>A study was conducted using TriNetX, a global federated health research network. Adult outpatients with cardiometabolic disease (i.e. diabetes mellitus and any disease of the circulatory system) treated with VKAs or DOACs at time of COVID-19 diagnosis between 20-Jan-2020 and 15-Feb-2021 were included. Propensity score matching (PSM) was used to balance cohorts receiving VKAs and DOACs. The primary outcomes were all-cause mortality, intensive care unit (ICU) admission/mechanical ventilation (MV) necessity, intracranial haemorrhage (ICH)/gastrointestinal bleeding, and the composite of any arterial or venous thrombotic event(s) at 30-days after COVID-19 diagnosis.<h4>Results</h4>2275 patients were included. After PSM, 1270 patients remained in the study (635 on VKAs; 635 on DOACs). VKA-treated patients had similar risks and 30-day event-free survival than patients on DOACs regarding all-cause mortality, ICU admission/MV necessity, and ICH/gastrointestinal bleeding. The risk of any arterial or venous thrombotic event was 43% higher in the VKA cohort (hazard ratio 1.43, 95% confidence interval 1.03-1.98; Log-Rank test p = 0.029).<h4>Conclusion</h4>In COVID-19 outpatients with cardiometabolic diseases, prior use of DOAC therapy compared to VKA therapy at the time of COVID-19 diagnosis demonstrated lower risk of arterial or venous thrombotic outcomes, without increasing the risk of bleeding.

Item Type:	Article
Uncontrolled Keywords:	Coronavirus disease 2019, SARS-CoV-2, Thrombosis, Anticoagulant, Vitamin K antagonist, Direct-acting oral anticoagulants, Bleeding
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	16 Sep 2021 09:40
Last Modified:	18 Jan 2023 21:28
DOI:	10.1186/s12933-021-01368-6
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3137267