Preexisting Oral Anticoagulant Therapy Ameliorates Prognosis in Hospitalized COVID-19 Patients

Frontiers in Cardiovascular Medicine

Guido Iaccarino²  Costantino Mancusi²  Claudio Ferri³  Davide Grassi³  Maria Lorenza Muiesan⁴  Massimo Salvetti⁴  Claudio Borghi⁵  Guido Grassi⁶  Massimo Volpe⁷ 

[1] Clinical and Molecular Medicine Department, Sapienza University, Rome, Italy;Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy;Department of Clinical Medicine, Public Health, Life and Environment Sciences, University of L'Aquila, L'Aquila, Italy;Department of Clinical and Experimental Sciences, University of Brescia, Medicina 2, ASST Spedali Civili Brescia, Brescia, Italy;Department of Medicine and Surgery Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy;Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy;Sant'Andrea Hospital, Rome, Italy;

关键词: multimorbidity;    atrial fibrillation;    prophylaxis;    death;    intensive care admissions;    COVID-19 outcomes;   

DOI  :  10.3389/fcvm.2021.633878

来源: DOAJ

【 摘 要 】

Objective: Altered coagulation parameters in COVID-19 patients is associated with a poor prognosis. We tested whether COVID-19 patients on chronic oral anticoagulants (cOACs) for thromboembolism prophylaxis could receive protection from developing more severe phenotypes of the disease.Approach and Results: We searched the database of the SARS-RAS study (Clinicaltrials.gov: NCT04331574), a cross-sectional observational multicenter nationwide survey in Italy designed by the Italian Society of Hypertension. The database counts 2,377 charts of Italian COVID-19 patients in 26 hospitals. We calculated the Charlson comorbidity index (CCI), which is associated with death in COVID-19 patients. In our population (n = 2,377, age 68.2 ± 0.4 years, CCI: 3.04 ± 0.04), we confirm that CCI is associated with increased mortality [OR: 1.756 (1.628-1.894)], admission to intensive care units [ICU; OR: 1.074 (1.017-1.134)], and combined hard events [CHE; OR: 1.277 (1.215-1.342)]. One hundred twenty-five patients were on cOACs (age: 79.3 ± 0.9 years, CCI: 4.35 ± 0.13); despite the higher CCI, cOACs patients presented with a lower risk of admissions to the ICU [OR 0.469 (0.250-0.880)] but not of death [OR: 1.306 (0.78-2.188)] or CHE [OR: 0.843 (0.541-1.312)]. In multivariable logistic regression, cOACs confirmed their protective effect on ICU admission and CHE. The CCI remains the most important risk factor for ICU admission, death, and CHE.Conclusions: Our data support a mechanism for the continuation of cOAC therapy after hospital admission for those patients who are on chronic treatment. Our preliminary results suggest the prophylactic use of direct cOACs in patients with elevated CCI score at the time of the COVID-19 pandemic even in absence of other risks of thromboembolism.

【 授权许可】

Unknown