Handy, Alex, Banerjee, Amitava, Wood, Angela M, Dale, Caroline, Sudlow, Cathie LM, Tomlinson, Christopher, Bean, Daniel, Thygesen, Johan H, Mizani, Mehrdad A, Katsoulis, Michail et al (show 7 more authors)
(2022)
Evaluation of antithrombotic use and COVID-19 outcomes in a nationwide atrial fibrillation cohort.
HEART, 108 (12).
923-+.
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Abstract
<h4>Objective</h4>To evaluate antithrombotic (AT) use in individuals with atrial fibrillation (AF) and at high risk of stroke (CHA<sub>2</sub>DS<sub>2</sub>-VASc score ≥2) and investigate whether pre-existing AT use may improve COVID-19 outcomes.<h4>Methods</h4>Individuals with AF and CHA<sub>2</sub>DS<sub>2</sub>-VASc score ≥2 on 1 January 2020 were identified using electronic health records for 56 million people in England and were followed up until 1 May 2021. Factors associated with pre-existing AT use were analysed using logistic regression. Differences in COVID-19-related hospitalisation and death were analysed using logistic and Cox regression in individuals with pre-existing AT use versus no AT use, anticoagulants (AC) versus antiplatelets (AP), and direct oral anticoagulants (DOACs) versus warfarin.<h4>Results</h4>From 972 971 individuals with AF (age 79 (±9.3), female 46.2%) and CHA<sub>2</sub>DS<sub>2</sub>-VASc score ≥2, 88.0% (n=856 336) had pre-existing AT use, 3.8% (n=37 418) had a COVID-19 hospitalisation and 2.2% (n=21 116) died, followed up to 1 May 2021. Factors associated with no AT use included comorbidities that may contraindicate AT use (liver disease and history of falls) and demographics (socioeconomic status and ethnicity). Pre-existing AT use was associated with lower odds of death (OR=0.92, 95% CI 0.87 to 0.96), but higher odds of hospitalisation (OR=1.20, 95% CI 1.15 to 1.26). AC versus AP was associated with lower odds of death (OR=0.93, 95% CI 0.87 to 0.98) and higher hospitalisation (OR=1.17, 95% CI 1.11 to 1.24). For DOACs versus warfarin, lower odds were observed for hospitalisation (OR=0.86, 95% CI 0.82 to 0.89) but not for death (OR=1.00, 95% CI 0.95 to 1.05).<h4>Conclusions</h4>Pre-existing AT use may be associated with lower odds of COVID-19 death and, while not evidence of causality, provides further incentive to improve AT coverage for eligible individuals with AF.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | CVD-COVID-UK Consortium, Humans, Atrial Fibrillation, Warfarin, Fibrinolytic Agents, Anticoagulants, Risk Assessment, Risk Factors, Aged, Female, Stroke, COVID-19 |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 12 Dec 2022 10:09 |
| Last Modified: | 18 Jan 2023 19:40 |
| DOI: | 10.1136/heartjnl-2021-320325 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3166606 |
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