Oral anticoagulation and clinical outcomes in COVID-19: An Italian multicenter experience. (15th January 2021)

• Record Type: Journal Article
• Authors: Schiavone, Marco; Gasperetti, Alessio; Mancone, Massimo; Curnis, Antonio; Mascioli, Giosuè; Mitacchione, Gianfranco; Busana, Mattia; Sabato, Federica; Gobbi, Cecilia; Antinori, Spinello; Galli, Massimo; Forleo, Giovanni Battista
• Is Part Of: International journal of cardiology. Volume 323(2021)
• Page Start: 276
• Page End: 280
• Publication Date: 2021-01-15
• Subjects: Anticoagulation -- Oral anticoagulants -- Heparin -- Microthrombosis -- Coagulopathy -- COVID-19; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.09.001
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Since the body of evidence addressing the coagulation derangements caused by Coronavirus disease (COVID-19) has been constantly growing, we investigated whether pre-hospitalization oral anticoagulation (OAC) or in-hospital heparin treatment could have a protective role among COVID-19 patients. Method: In this cohort study, consecutive COVID-19 patients admitted to four different Italian Institutions were enrolled. Baseline demographic, clinical, laboratory, and radiological characteristics, as well as in-hospital treatment and outcomes were evaluated. The primary outcome was mortality. Results: A total of 844 COVID-19 patients were enrolled as study cohort, n = 65 (7.7%) taking OACs prior to hospitalization. Regarding clinical outcomes, OAC patients developed acute hypoxemic respiratory failure (AHRF) more frequently than non-OAC patients as well as presenting a higher mortality rate (44.6% vs 19.8%, p < 0.001). At overall multivariate logistical regression, use of heparin ( n = 394, 46.6%) was associated with a better chance of survival to hospital discharge (OR 0.60 [0.38–0.94], p < 0.001), in particular in patients with AHRF, with no association found with the use of OACs. In a sub-analysis, the highest mortality rate was found for AHRF patients when heparin was not administered. Conclusion: In our cohort, OACs appeared to be ineffective in reducing mortality rate, while heparin resulted to be a useful treatment when lung disease was sufficiently severe, potentially suggesting a crucial role of microthrombosis in severe COVID-19. Due to the relatively small number of COVID-19 patients treated with OACs included in our analysis and their higher number of comorbidities, larger studies are needed in order to confirm our findings. Highlights: Evidence on a prothrombotic asset caused by COVID-19 has been constantly growing. In our cohort, OACs appeared to be ineffective in reducing mortality rate. Heparin resulted to be a useful treatment when lung disease was sufficiently severe. Microthrombosis may have a crucial role in COVID-19. Due to the relatively small sample size of OAC patients included, larger studies are needed.