Key result
Prior use of vitamin K antagonists in COVID-19 outpatients with cardiometabolic diseases was associated with a 43% higher risk of arterial or venous thrombotic events compared to direct-acting oral anticoagulants (HR 1.43).
Why the study?
It remained uncertain whether prior use of oral anticoagulants affects prognosis in COVID-19 outpatients with multimorbidity, particularly in the presence of cardiometabolic diseases.
Does prior use of direct-acting oral anticoagulants compared to vitamin K antagonists reduce 30-day adverse clinical outcomes in COVID-19 outpatients with cardiometabolic diseases?
Cohort (n=2,275)
Yes
Does prior use of direct-acting oral anticoagulants compared to vitamin K antagonists reduce 30-day adverse clinical outcomes in COVID-19 outpatients with cardiometabolic diseases?
Hazard Ratio: 1.43 (95% CI 1.03–1.98)
Absolute Event Rate: 14.02% vs 9.61%
p-value: p=0.029
In COVID-19 outpatients with cardiometabolic diseases, prior DOAC therapy was associated with a lower 30-day risk of arterial or venous thrombotic events compared to VKA therapy, without increasing bleeding risk.
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
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Rivera‐Caravaca et al. (2021) conducted a cohort in COVID-19 with cardiometabolic diseases (n=2,275). Vitamin K antagonists (VKAs) vs. Direct-acting oral anticoagulants (DOACs) was evaluated on Composite of any arterial or venous thrombotic event at 30 days (HR 1.43, 95% CI 1.03-1.98, p=0.029). Prior use of vitamin K antagonists in COVID-19 outpatients with cardiometabolic diseases was associated with a 43% higher risk of arterial or venous thrombotic events compared to direct-acting oral anticoagulants (HR 1.43).
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