TY - JOUR
T1 - Does chronic oral anticoagulation reduce in-hospital mortality among COVID-19 older patients?
AU - Covino, Marcello
AU - De Matteis, Giuseppe
AU - Della Polla, Davide
AU - Burzo, Maria Livia
AU - Pascale, Marco Maria
AU - Santoro, Marco
AU - De Cristofaro, Raimondo
AU - Gasbarrini, Antonio
AU - De Candia, Erica
AU - Franceschi, Francesco
PY - 2021
Y1 - 2021
N2 - Background: Patients hospitalized with COVID-19 experienced an increased risk of venous thromboembolism. Aims: To evaluate the effect of chronic oral anticoagulation (OAC) therapy, both with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs), on prognosis of COVID-19 older patients. Methods: Single-center prospective study conducted in the Emergency Department (ED) of a teaching hospital, referral center for COVID-19 in central Italy. We evaluated all the patients ≥ 65 years, consecutively admitted to our ED for confirmed COVID-19. We compared the clinical outcome of those who were on chronic OAC at ED admission with those who did not, using a propensity score matched paired cohort of controls. The primary study endpoint was all-cause in-hospital death. Patients were matched for age, sex, clinical comorbidities, and clinical severity at presentation (based on NEWS ≥ 6). Study parameters were assessed for association to all-cause in-hospital death by a multivariate Cox regression analysis to identify independent risk factor for survival. Results: Although overall mortality was slightly higher for anticoagulated patients compared to controls (63.3% vs 43.5%, p = 0.012), the multivariate adjusted hazard ratio (HR) for death was not significant (HR = 1.56 [0.78–3.12]; p = 0.208). Both DOACs (HR 1.46 [0.73–2.92]; p = 0.283) and VKAs (HR 1.14 [0.48–2.73]; p = 0.761) alone did not affect overall survival in our cohort. Conclusions: Among older patients hospitalized for COVID-19, chronic OAC therapy was not associated with a reduced risk of in-hospital death. Moreover, our data suggest similar outcome both for patients on VKAs or in patients on DOACs.
AB - Background: Patients hospitalized with COVID-19 experienced an increased risk of venous thromboembolism. Aims: To evaluate the effect of chronic oral anticoagulation (OAC) therapy, both with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs), on prognosis of COVID-19 older patients. Methods: Single-center prospective study conducted in the Emergency Department (ED) of a teaching hospital, referral center for COVID-19 in central Italy. We evaluated all the patients ≥ 65 years, consecutively admitted to our ED for confirmed COVID-19. We compared the clinical outcome of those who were on chronic OAC at ED admission with those who did not, using a propensity score matched paired cohort of controls. The primary study endpoint was all-cause in-hospital death. Patients were matched for age, sex, clinical comorbidities, and clinical severity at presentation (based on NEWS ≥ 6). Study parameters were assessed for association to all-cause in-hospital death by a multivariate Cox regression analysis to identify independent risk factor for survival. Results: Although overall mortality was slightly higher for anticoagulated patients compared to controls (63.3% vs 43.5%, p = 0.012), the multivariate adjusted hazard ratio (HR) for death was not significant (HR = 1.56 [0.78–3.12]; p = 0.208). Both DOACs (HR 1.46 [0.73–2.92]; p = 0.283) and VKAs (HR 1.14 [0.48–2.73]; p = 0.761) alone did not affect overall survival in our cohort. Conclusions: Among older patients hospitalized for COVID-19, chronic OAC therapy was not associated with a reduced risk of in-hospital death. Moreover, our data suggest similar outcome both for patients on VKAs or in patients on DOACs.
KW - Administration, Oral
KW - Anticoagulants
KW - COVID-19
KW - Direct oral anticoagulants
KW - Hospital Mortality
KW - Humans
KW - Italy
KW - Older patients
KW - Oral anticoagulation
KW - Prospective Studies
KW - Retrospective Studies
KW - SARS-CoV-2
KW - Vitamin K
KW - Vitamin k antagonists
KW - Administration, Oral
KW - Anticoagulants
KW - COVID-19
KW - Direct oral anticoagulants
KW - Hospital Mortality
KW - Humans
KW - Italy
KW - Older patients
KW - Oral anticoagulation
KW - Prospective Studies
KW - Retrospective Studies
KW - SARS-CoV-2
KW - Vitamin K
KW - Vitamin k antagonists
UR - http://hdl.handle.net/10807/183221
U2 - 10.1007/s40520-021-01924-w
DO - 10.1007/s40520-021-01924-w
M3 - Article
SN - 1594-0667
VL - 33
SP - 2335
EP - 2343
JO - Aging clinical and experimental research
JF - Aging clinical and experimental research
ER -