Clin Res Cardiol . Pre-medication with oral anticoagulants is associated with better outcomes in a large multinational COVID-19 cohort with cardiovascular comorbidities

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Clin Res Cardiol


. 2021 Sep 21.
doi: 10.1007/s00392-021-01939-3. Online ahead of print.
Pre-medication with oral anticoagulants is associated with better outcomes in a large multinational COVID-19 cohort with cardiovascular comorbidities


Marina Rieder ^{# 1 2} , Nadine Gauchel ^{# 3 4} , Klaus Kaier ⁵ , Carolin Jakob ^{6 7} , Stefan Borgmann ⁸ , Annika Y Classen ^{6 7} , Jochen Schneider ⁹ , Lukas Eberwein ¹⁰ , Martin Lablans ^{11 12} , Maria Rüthrich ^{13 14} , Sebastian Dolff ¹⁵ , Kai Wille ¹⁶ , Martina Haselberger ¹⁷ , Hanno Heuzeroth ¹⁸ , Christoph Bode ^{1 2} , Constantin von Zur Mühlen ^{1 2} , Siegbert Rieg ^{# 19} , Daniel Duerschmied ^{# 1 2}



Affiliations

• PMID: 34546427
• DOI: 10.1007/s00392-021-01939-3

Abstract

Aims: 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.

Keywords: COVID-19; Oral anticoagulation; SARS-CoV-2; Thrombosis.