Efficacy and safety of direct-acting oral anticoagulants compared to vitamin K antagonists in COVID-19 outpatients with cardiometabolic diseases

• Published in: Cardiovascular diabetology 2021-09, Vol.20 (1), p.176-11, Article 176
• Main Authors: Rivera-Caravaca, José Miguel, Harrison, Stephanie L, Buckley, Benjamin J R, Fazio-Eynullayeva, Elnara, Underhill, Paula, Marín, Francisco, Lip, Gregory Y H
• Format: Article
• Language: English
• Subjects: Administration, Oral; Aged; Aged, 80 and over; Ambulatory Care - methods; Antagonists; Anticoagulant; Anticoagulants; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Bleeding; Circulatory system; Coronavirus disease 2019; Coronaviruses; COVID-19; COVID-19 - diagnosis; COVID-19 - mortality; COVID-19 Drug Treatment; Diabetes mellitus; Diagnosis; Direct-acting oral anticoagulants; Factor Xa Inhibitors - administration & dosage; Female; Follow-Up Studies; Heart Diseases - diagnosis; Heart Diseases - drug therapy; Heart Diseases - mortality; Hemorrhage; Hemorrhage - chemically induced; Hemorrhage - mortality; Humans; Intensive Care Units - trends; Male; Mechanical ventilation; Metabolic Diseases - diagnosis; Metabolic Diseases - drug therapy; Metabolic Diseases - mortality; Middle Aged; Mortality; Mortality - trends; Original Investigation; Patients; SARS-CoV-2; Stroke; Thrombosis; Treatment Outcome; Vitamin K; Vitamin K - antagonists & inhibitors; Vitamin K antagonist
• ISSN: 1475-2840; 1475-2840
• DOI: 10.1186/s12933-021-01368-6

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.