Ongoing direct oral anticoagulant use not associated with reduced risk of severe COVID-19

Prognosis would not be modified by early outpatient DOAC initiation as per Journal of Internal Medicine.

“Identified as a key feature of severe COVID-19, large focus has been put on managing hypercoagulability in hospitalized patients, with interim guidelines supportive of anticoagulation,” wrote researchers led by Benjamin Flam, MD, Karolinska University Hospital, Stockholm, Sweden. “Pre-emptive anticoagulant treatment before or at the time of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection to protect against severe disease is theoretically appealing but real-world data have been lacking. Previously, only small studies of COVID-19 patient cohorts have been conducted showing mixed results.”

The researchers conducted a nationwide register-based cohort study in Sweden from February through May, 2020 to assess whether ongoing DOAC use was associated with reduced risk of hospital admission for COVID-19, or a composite of intensive care unit (ICU) admission or death due to COVID-19.

Within the cohort, 103,703 (mean age, 73.6 years) were patients with non-valvular atrial fibrillation (AF) who were DOAC users, 90% of whom were using direct factor Xa inhibitors. Meanwhile, the comparator groups included 36,875 (mean age, 66.4 years) patients with AF with no DOAC use and 355,699 (mean age, 69.3 years) patients with cardiovascular disease (CVD) with no DOAC use.

There were 360 hospital admissions for COVID-19 among the DOAC users (crude risk, 0.35%), compared to 95 among non-users with AF (0.26%) and 1,119 among non-users with CVD (0.31%).

Meanwhile, 161 composite ICU admission or death due to COVID-19 outcome events occurred among the DOAC users (crude risk, 0.16%), compared to 55 among non-users with AF (0.15%) and 473 among non-users with CVD (0.13%).

DOAC use, compared with non-use, was not associated with reduced risk of hospital admission for COVID-19. Both outcomes were similar for both DOAC subtypes (direct thrombin inhibitor and direct factor Xa inhibitors).

Rather than against secondary hypercoagulability, therapies may be better directed against thrombogenic inflammation or vasculopathy, but further investigation is required.

Dr. KK Aggarwal, President, CMAAO said, “We cannot interpolate of the results as in COVID 19 its thrombo inflammation and results have to be compared whether they were given early steroids or not to stop inflammation.”