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Evaluation of antithrombotic use and COVID-19 outcomes in a nationwide atrial fibrillation cohort.

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posted on 2023-05-17, 09:08 authored by Alex Handy, Amitava Banerjee, Angela M Wood, Caroline Dale, Cathie LM Sudlow, Christopher Tomlinson, Daniel Bean, Johan H Thygesen, Mehrdad A Mizani, Michail Katsoulis, Rohan Takhar, Sam Hollings, Spiros Denaxas, Venexia Walker, Richard Dobson, Reecha Sofat, CVD-COVID-UK Consortium

Objective To evaluate antithrombotic (AT) use in individuals with atrial fibrillation (AF) and at high risk of stroke (CHA2DS2-VASc score ≥2) and investigate whether pre-existing AT use may improve COVID-19 outcomes.


Methods Individuals with AF and CHA2DS2-VASc score ≥2 on 1 January 2020 were identified using electronic health records for 56 million people in England and were followed up until 1 May 2021. Factors associated with pre-existing AT use were analysed using logistic regression. Differences in COVID-19-related hospitalisation and death were analysed using logistic and Cox regression in individuals with pre-existing AT use versus no AT use, anticoagulants (AC) versus antiplatelets (AP), and direct oral anticoagulants (DOACs) versus warfarin.


Results From 972 971 individuals with AF (age 79 (±9.3), female 46.2%) and CHA2DS2-VASc score ≥2, 88.0% (n=856 336) had pre-existing AT use, 3.8% (n=37 418) had a COVID-19 hospitalisation and 2.2% (n=21 116) died, followed up to 1 May 2021. Factors associated with no AT use included comorbidities that may contraindicate AT use (liver disease and history of falls) and demographics (socioeconomic status and ethnicity). Pre-existing AT use was associated with lower odds of death (OR=0.92, 95% CI 0.87 to 0.96), but higher odds of hospitalisation (OR=1.20, 95% CI 1.15 to 1.26). AC versus AP was associated with lower odds of death (OR=0.93, 95% CI 0.87 to 0.98) and higher hospitalisation (OR=1.17, 95% CI 1.11 to 1.24). For DOACs versus warfarin, lower odds were observed for hospitalisation (OR=0.86, 95% CI 0.82 to 0.89) but not for death (OR=1.00, 95% CI 0.95 to 1.05).


Conclusions Pre-existing AT use may be associated with lower odds of COVID-19 death and, while not evidence of causality, provides further incentive to improve AT coverage for eligible individuals with AF.

History

Author affiliation

Department of Health Sciences, University of Leicester

Version

  • VoR (Version of Record)

Published in

Heart (British Cardiac Society)

Volume

108

Issue

12

Pagination

923 - 931

Publisher

BMJ

issn

1355-6037

eissn

1468-201X

Copyright date

2022

Available date

2023-05-17

Spatial coverage

England

Language

eng

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