Clinical profile and prognosis in patients on oral anticoagulation before admission for COVID‐19

Rivera‐Caravaca, José Miguel; Núñez‐Gil, Iván J.; Vivas, David; Viana‐Llamas, María C.; Uribarri, Aitor; Becerra‐Muñoz, Víctor Manuel; Trabattoni, Daniela; Fernández Rozas, Inmaculada; Feltes, Gisela; López‐Pais, Javier; El‐Battrawy, Ibrahim; Macaya, Carlos; Fernandez‐Ortiz, Antonio; Estrada, Vicente; Marín, Francisco

BACKGROUND: The coronavirus disease 2019 (COVID‐19) shown high morbidity and mortality, particularly in patients with concomitant cardiovascular diseases. Some of these patients are under oral anticoagulation (OAC) at admission but to date, there are no data on the clinical profile, prognosis, and risk factors of such patients during hospitalization for COVID‐19. DESIGN: Sub‐analysis of the international ‘real‐world’ HOPE COVID‐19 registry. All patients with prior OAC at hospital admission for COVID‐19 were suitable for the study. All‐cause mortality was the primary endpoint. RESULTS: From 1002 patients included, 110 were on OAC (60.9% male, median age of 81.5 [IQR 75‐87] years, median Short‐Form Charlson Comorbidity Index [CCI] of 1 [IQR 1‐3]) at admission, mainly for atrial fibrillation and venous thromboembolism. After propensity score matching, 67.9% of these patients died during hospitalization, which translated into a significantly higher mortality risk compared to patients without prior OAC (HR 1.53, 95% CI 1.08‐2.16). After multivariate Cox regression analysis, respiratory insufficiency during hospitalization (HR 6.02, 95% CI 2.18‐16.62), systemic inflammatory response syndrome (SIRS) during hospitalization (HR 2.29, 95% CI 1.34‐3.91), and the short‐form CCI (HR 1.24, 95% CI 1.03‐1.49) were the main risk factors for mortality in patients on prior OAC. CONCLUSION: Compared to patients without prior OAC, COVID‐19 patients on OAC therapy at hospital admission showed lower survival and higher mortality risk. In these patients on OAC therapy, the prevalence of several comorbidities is high. Respiratory insufficiency and SIRS during hospitalization, as well as higher comorbidity, pointed‐out those anticoagulated patients with increased mortality risk.