tetano
Editor, Senior Moderator
Thromb Res
. 2021 Dec 13;211:114-122.
doi: 10.1016/j.thromres.2021.12.010. Online ahead of print.
The association between anticoagulation and adverse outcomes after a positive SARS-CoV-2 test among older outpatients: A population-based cohort study
Husam Abdel-Qadir[SUP] 1 [/SUP], Peter C Austin[SUP] 2 [/SUP], Andrea Pang[SUP] 3 [/SUP], Jiming Fang[SUP] 3 [/SUP], Jacob A Udell[SUP] 4 [/SUP], William H Geerts[SUP] 5 [/SUP], Candace D McNaughton[SUP] 6 [/SUP], Cynthia A Jackevicius[SUP] 7 [/SUP], Jeffrey C Kwong[SUP] 8 [/SUP], Calvin H Yeh[SUP] 9 [/SUP], Jafna L Cox[SUP] 10 [/SUP], Douglas S Lee[SUP] 11 [/SUP], Dennis T Ko[SUP] 12 [/SUP], Clare L Atzema[SUP] 12 [/SUP]
Affiliations
Abstract
Introduction: Anticoagulation may improve outcomes in patients with COVID-19 when started early in the course of illness.
Materials and methods: This was a population-based cohort study using linked administrative datasets of outpatients aged ≥65 years old testing positive for SARS-CoV-2 between January 1 and December 31, 2020 in Ontario, Canada. The key exposure was anticoagulation with warfarin or direct oral anticoagulants before COVID-19 diagnosis. We calculated propensity scores and used matching weights (MWs) to reduce baseline differences between anticoagulated and non-anticoagulated patients. The primary outcome was a composite of death or hospitalization within 60 days of a positive SARS-CoV-2 test. We used the Kaplan-Meier method and cumulative incidence functions to estimate risk of the primary and component outcomes at 60 days.
Results: We studied 23,159 outpatients (mean age 78.5 years; 13,474 [58.2%] female), among whom 3200 (13.8%) deaths and 3183 (13.7%) hospitalizations occurred within 60 days of the SARS-CoV-2 test. After application of MWs, the 60-day risk of death or hospitalization was 29.2% (95% CI 27.4%-31.2%) for anticoagulated individuals and 32.1% (95% CI 30.7%-33.5%) without anticoagulation (absolute risk difference [ARD], -2.9%; p = 0.005). Anticoagulation was also associated with a lower risk of death: 18.6% (95% CI 17.0%-20.2%) with anticoagulation and 20.9% (95% CI 19.7%-22.2%) in non-anticoagulated patients (ARD -2.3%; p = 0.005).
Conclusions: Among outpatients aged ≥65 years, oral anticoagulation at the time of a positive SARS-CoV-2 test was associated with a lower risk of a composite of death or hospitalization within 60 days.
Keywords: Anticoagulants; Coronavirus disease 2019 (COVID-19); Hospitalization; Mortality; SARS-CoV-2.
. 2021 Dec 13;211:114-122.
doi: 10.1016/j.thromres.2021.12.010. Online ahead of print.
The association between anticoagulation and adverse outcomes after a positive SARS-CoV-2 test among older outpatients: A population-based cohort study
Husam Abdel-Qadir[SUP] 1 [/SUP], Peter C Austin[SUP] 2 [/SUP], Andrea Pang[SUP] 3 [/SUP], Jiming Fang[SUP] 3 [/SUP], Jacob A Udell[SUP] 4 [/SUP], William H Geerts[SUP] 5 [/SUP], Candace D McNaughton[SUP] 6 [/SUP], Cynthia A Jackevicius[SUP] 7 [/SUP], Jeffrey C Kwong[SUP] 8 [/SUP], Calvin H Yeh[SUP] 9 [/SUP], Jafna L Cox[SUP] 10 [/SUP], Douglas S Lee[SUP] 11 [/SUP], Dennis T Ko[SUP] 12 [/SUP], Clare L Atzema[SUP] 12 [/SUP]
Affiliations
- PMID: 35149396
- DOI: 10.1016/j.thromres.2021.12.010
Abstract
Introduction: Anticoagulation may improve outcomes in patients with COVID-19 when started early in the course of illness.
Materials and methods: This was a population-based cohort study using linked administrative datasets of outpatients aged ≥65 years old testing positive for SARS-CoV-2 between January 1 and December 31, 2020 in Ontario, Canada. The key exposure was anticoagulation with warfarin or direct oral anticoagulants before COVID-19 diagnosis. We calculated propensity scores and used matching weights (MWs) to reduce baseline differences between anticoagulated and non-anticoagulated patients. The primary outcome was a composite of death or hospitalization within 60 days of a positive SARS-CoV-2 test. We used the Kaplan-Meier method and cumulative incidence functions to estimate risk of the primary and component outcomes at 60 days.
Results: We studied 23,159 outpatients (mean age 78.5 years; 13,474 [58.2%] female), among whom 3200 (13.8%) deaths and 3183 (13.7%) hospitalizations occurred within 60 days of the SARS-CoV-2 test. After application of MWs, the 60-day risk of death or hospitalization was 29.2% (95% CI 27.4%-31.2%) for anticoagulated individuals and 32.1% (95% CI 30.7%-33.5%) without anticoagulation (absolute risk difference [ARD], -2.9%; p = 0.005). Anticoagulation was also associated with a lower risk of death: 18.6% (95% CI 17.0%-20.2%) with anticoagulation and 20.9% (95% CI 19.7%-22.2%) in non-anticoagulated patients (ARD -2.3%; p = 0.005).
Conclusions: Among outpatients aged ≥65 years, oral anticoagulation at the time of a positive SARS-CoV-2 test was associated with a lower risk of a composite of death or hospitalization within 60 days.
Keywords: Anticoagulants; Coronavirus disease 2019 (COVID-19); Hospitalization; Mortality; SARS-CoV-2.