Pre-medication with oral anticoagulants is associated with better outcomes in a large multinational COVID-19 cohort with cardiovascular comorbidities,Clinical Research in Cardiology

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Pre-medication with oral anticoagulants is associated with better outcomes in a large multinational COVID-19 cohort with cardiovascular comorbidities
Clinical Research in Cardiology ( IF 5 ) Pub Date : 2021-09-21 , DOI: 10.1007/s00392-021-01939-3
Marina Rieder _{1,

2} , Nadine Gauchel _{1,

2} , Klaus Kaier ₃ , Carolin Jakob _{4,

5} , Stefan Borgmann ₆ , Annika Y Classen _{4,

5} , Jochen Schneider ₇ , Lukas Eberwein ₈ , Martin Lablans _{9,

10} , Maria Rüthrich _{11,

12} , Sebastian Dolff ₁₃ , Kai Wille ₁₄ , Martina Haselberger ₁₅ , Hanno Heuzeroth ₁₆ , Christoph Bode _{1,

2} , Constantin von Zur Mühlen _{1,

2} , Siegbert Rieg ₁₇ , Daniel Duerschmied _{1,

2}

Affiliation

Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
Institute of Medical Biometry and Statistics, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany.
Department I for Internal Medicine, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany.
German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
Department of Infectious Diseases and Infection Control, Ingolstadt Hospital, Ingolstadt, Germany.
School of Medicine, Technical University of Munich, University Hospital Rechts der Isar, Munich, Germany.
4Th Department of Internal Medicine, Klinikum Leverkusen, Leverkusen, Germany.
Federated Information Systems, German Cancer Research Center, Heidelberg, Germany.
University Medical Center Mannheim, Mannheim, Germany.
Department for Internal Medicine II, Hematology and Medical Oncology, University Hospital Jena, Jena, Germany.
Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knöll Institute, Jena, Germany.
Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Duisburg, Germany.
University Clinic for Haematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Bochum, Germany.
Department of Medicine I, Passau Municipal Hospital, Passau, Germany.
Department of Emergency and Intensive Care Medicine, Klinikum Ernst-Von-Bergmann, Potsdam, Germany.
Division of Infectious Diseases, Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

Aims

Coagulopathy and venous thromboembolism are common findings in coronavirus disease 2019 (COVID-19) and are associated with poor outcome. Timely initiation of anticoagulation after hospital admission was shown to be beneficial. In this study we aim to examine the association of pre-existing oral anticoagulation (OAC) with outcome among a cohort of SARS-CoV-2 infected patients.

Methods and results

We analysed the data from the large multi-national Lean European Open Survey on SARS-CoV-2 infected patients (LEOSS) from March to August 2020. Patients with SARS-CoV-2 infection were eligible for inclusion. We retrospectively analysed the association of pre-existing OAC with all-cause mortality. Secondary outcome measures included COVID-19-related mortality, recovery and composite endpoints combining death and/or thrombotic event and death and/or bleeding event. We restricted bleeding events to intracerebral bleeding in this analysis to ensure clinical relevance and to limit reporting errors. A total of 1 433 SARS-CoV-2 infected patients were analysed, while 334 patients (23.3%) had an existing premedication with OAC and 1 099 patients (79.7%) had no OAC. After risk adjustment for comorbidities, pre-existing OAC showed a protective influence on the endpoint death (OR 0.62, P = 0.013) as well as the secondary endpoints COVID-19-related death (OR 0.64, P = 0.023) and non-recovery (OR 0.66, P = 0.014). The combined endpoint death or thrombotic event tended to be less frequent in patients on OAC (OR 0.71, P = 0.056).

Conclusions

Pre-existing OAC is protective in COVID-19, irrespective of anticoagulation regime during hospital stay and independent of the stage and course of disease.

Graphic abstract

中文翻译：

在有心血管合并症的大型跨国 COVID-19 队列中，预先使用口服抗凝剂与更好的结果相关

目标

凝血病和静脉血栓栓塞是 2019 年冠状病毒病 (COVID-19) 的常见发现，并且与不良结果相关。入院后及时开始抗凝治疗被证明是有益的。在这项研究中，我们旨在检查预先存在的口服抗凝剂 (OAC) 与一组 SARS-CoV-2 感染患者的预后之间的关系。

方法和结果

我们分析了 2020 年 3 月至 2020 年 8 月对 SARS-CoV-2 感染患者 (LEOSS) 进行的大型多国精益欧洲公开调查的数据。感染 SARS-CoV-2 的患者有资格入选。我们回顾性分析了预先存在的 OAC 与全因死亡率的关系。次要结果测量包括与 COVID-19 相关的死亡率、康复和复合终点，包括死亡和/或血栓形成事件以及死亡和/或出血事件。在该分析中，我们将出血事件限制在脑内出血，以确保临床相关性并限制报告错误。共分析了 1 433 名 SARS-CoV-2 感染患者，其中 334 名患者（23.3%）已有 OAC 的术前用药，1 099 名患者（79.7%）没有 OAC。在对合并症进行风险调整后，P = 0.013）以及次要终点 COVID-19 相关死亡（OR 0.64，P = 0.023）和未康复（OR 0.66，P = 0.014）。在使用 OAC 的患者中，合并终点死亡或血栓事件的发生率往往较低（OR 0.71，P = 0.056）。