Pre–arrest oral anticoagulants’ impact on cardiac arrest mortality: MIMIC–IV cohort retrospect

Q: What are the key findings of this study?

Pre-arrest oral anticoagulant use was associated with a significantly lower risk of 28-day all-cause mortality compared to non-use in patients with cardiac arrest (HR 0.40).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiac arrest (n=1203). Intervention: Pre-arrest oral anticoagulants vs. No pre-arrest oral anticoagulants. Primary outcome: 28-day all-cause mortality (HR 0.40, 95% CI 0.27-0.60, p=<0.001).

Q: What does this research mean for the field?

Pre-arrest oral anticoagulant use is associated with significantly reduced 28-day all-cause mortality and improved extended survival in cardiac arrest patients. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Li He; Xiangde Zheng

doi:10.3389/fcvm.2025.1599318

November 3, 2025Frontiers in Cardiovascular MedicineOpen Access

Pre–arrest oral anticoagulants’ impact on cardiac arrest mortality: MIMIC–IV cohort retrospect

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Key result

Pre-arrest oral anticoagulant use is linked to ~60% lower 28-day mortality after cardiac arrest.

HR 0.40
95% CI 0.27-0.60
P<0.001
n=1,203

Figures

Why the study?

The impact of oral anticoagulant use prior to cardiac arrest on short-term and long-term all-cause mortality remains largely unknown.

Does pre-arrest oral anticoagulant use improve survival in adult cardiac arrest patients?

Study Design

Type

Cohort (n=1,203)

Multicenter

No

Structured PICO

Does pre-arrest oral anticoagulant use improve survival in adult cardiac arrest patients?

P

Population

1,203 adult patients with non-traumatic, non-surgical cardiac arrest admitted to the ICU for at least 24 hours, followed for up to 365 days.

E

Exposure

Pre-arrest oral anticoagulant use

C

Comparator

No pre-arrest oral anticoagulant use

O

Outcome

28-day survival ratehard clinical

Main Result

Hazard Ratio: 0.4 (95% CI 0.27–0.6)

p-value: p=<0.001

Pre-arrest use of oral anticoagulants is associated with significantly improved short- and long-term survival in patients who experience cardiac arrest.

Limitations

Observational nature of the study inherently limits causal inference.
Potential for unmeasured confounders such as pre-arrest neurological status, socioeconomic factors, or variability in resuscitation protocols.
Lack of granular temporal data (e.g., precise timestamps for cardiac arrest events).
Does not systematically record in-hospital adjustments to anticoagulant therapy (e.g., discontinuation or transitions to parenteral agents).
Exclusion of short-stay ICU patients, traumatic/post-operative cases, and individuals <18 years limits generalizability.
Unable to assess whether oral anticoagulant use provided added benefits in conditions associated with elevated thrombotic risk or if it led to increased bleeding events.

Implication

Pre-arrest OAC use was associated with better CA survival; hypothesis-generating and should not change practice pending trials.

Abstract

Background The impact of oral anticoagulant use prior to cardiac arrest (CA) on short-term and long-term all-cause mortality remains largely unknown. This study aimed to explore the association between pre-arrest oral anticoagulant use and both immediate and extended survival outcomes following CA. Methods We identified 1,203 adult CA patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV V3.1) database, grouped by prior oral anticoagulant use. Propensity score matching (PSM) was conducted to minimize confounding effects. Adjusted Cox proportional hazards models were applied to account for pre-hospital and hospitalization factors. Results Patients in the anticoagulant group demonstrated a significantly higher 28-day survival rate [hazard ratio (HR) 0.28; 95% confidence interval (CI) 0.22–0.37; P < 0.001]. After PSM, 120 patients were assigned to the anticoagulant group and 130 to the non-anticoagulant group. In the matched cohort, patients in the anticoagulant group continued to demonstrate improved 28-day survival compared to the non-anticoagulant group (HR 0.40; 95% CI 0.27–0.60; P < 0.001). Consistent survival benefits were observed at 90, 180, and 365 days. Subgroup analyses further supported these findings. Conclusion Pre-arrest oral anticoagulant use may be associated with improved survival outcomes in CA patients.

Discussion

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Cite This Study

He et al. (2025) conducted a cohort in Cardiac arrest (n=1,203). Pre-arrest oral anticoagulants vs. No pre-arrest oral anticoagulants was evaluated on 28-day all-cause mortality (HR 0.40, 95% CI 0.27-0.60, p=<0.001). Pre-arrest oral anticoagulant use was associated with a significantly lower risk of 28-day all-cause mortality compared to non-use in patients with cardiac arrest (HR 0.40).

synapsesocial.com/papers/6ab2163ef85cbd26dd7dc009 https://doi.org/10.3389/fcvm.2025.1599318

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Pre–arrest oral anticoagulants’ impact on cardiac arrest mortality: MIMIC–IV cohort retrospect

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Pre–arrest oral anticoagulants’ impact on cardiac arrest mortality: MIMIC–IV cohort retrospect

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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