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. 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. 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). 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.

中文翻译：

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与维生素 K 拮抗剂相比，直接作用口服抗凝剂在 COVID-19 心脏代谢疾病门诊患者中的疗效和安全性

尚不确定在 COVID-19 门诊患者中先前使用口服抗凝剂 (OAC) 是否会影响预后，尤其是在存在心脏代谢疾病的情况下。在 COVID-19 诊断后接受维生素 K 拮抗剂 (VKA) 或直接作用 OAC (DOAC) 治疗的心脏代谢疾病门诊患者在 COVID-19 诊断后 30 天的临床结果进行了比较。使用全球联合健康研究网络 TriNetX 进行了一项研究。纳入了在 2020 年 1 月 20 日至 2021 年 2 月 15 日诊断 COVID-19 时接受 VKA 或 DOAC 治疗的心脏代谢疾病（即糖尿病和任何循环系统疾病）的成年门诊患者。倾向评分匹配 (PSM) 用于平衡接受 VKA 和 DOAC 的队列。主要结果是全因死亡率，重症监护病房 (ICU) 入院/机械通气 (MV) 必要性、颅内出血 (ICH)/胃肠道出血，以及 COVID-19 诊断后 30 天的任何动脉或静脉血栓事件的复合。包括 2275 名患者。PSM 后，1270 名患者仍在研究中（635 名使用 VKA；635 名使用 DOAC）。在全因死亡率、ICU 入住/MV 必要性和 ICH/胃肠道出血方面，接受 VKA 治疗的患者与接受 DOAC 治疗的患者相比，具有相似的风险和 30 天无事件生存率。VKA 队列中任何动脉或静脉血栓形成事件的风险高出 43%（风险比 1.43，95% 置信区间 1.03–1.98；对数秩检验 p = 0.029）。在患有心脏代谢疾病的 COVID-19 门诊患者中，