Association between oral anticoagulants and COVID-19-related outcomes: a population-based cohort study

(The OpenSAFELY Collaborative)

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Early evidence has shown that anticoagulant reduces the risk of thrombotic events in those infected with COVID-19. However, evidence of the role of routinely prescribed oral anticoagulants (OACs) in COVID-19 outcomes is limited.

AIM: To investigate the association between OACs and COVID-19 outcomes in those with atrial fibrillation and a CHA 2DS 2-VASc score of 2.

DESIGN AND SETTING: On behalf of NHS England, a population-based cohort study was conducted.

METHOD: The study used primary care data and pseudonymously-linked SARS-CoV-2 antigen testing data, hospital admissions, and death records from England. Cox regression was used to estimate hazard ratios (HRs) for COVID-19 outcomes comparing people with current OAC use versus non-use, accounting for age, sex, comorbidities, other medications, deprivation, and general practice.

RESULTS: Of 71 103 people with atrial fibrillation and a CHA 2DS 2-VASc score of 2, there were 52 832 current OAC users and 18 271 non-users. No difference in risk of being tested for SARS-CoV-2 was associated with current use (adjusted HR [aHR] 0.99, 95% confidence interval [CI] = 0.95 to 1.04) versus non-use. A lower risk of testing positive for SARS-CoV-2 (aHR 0.77, 95% CI = 0.63 to 0.95) and a marginally lower risk of COVID-19-related death (aHR, 0.74, 95% CI = 0.53 to 1.04) were associated with current use versus non-use.

CONCLUSION: Among those at low baseline stroke risk, people receiving OACs had a lower risk of testing positive for SARS-CoV-2 and severe COVID-19 outcomes than non-users; this might be explained by a causal effect of OACs in preventing severe COVID-19 outcomes or unmeasured confounding, including more cautious behaviours leading to reduced infection risk.

Original languageEnglish
Pages (from-to)e456-e463
JournalBritish Journal of General Practice
Volume72
Issue number720
DOIs
Publication statusPublished - 30 Jun 2022
Externally publishedYes

Keywords

  • Administration, Oral
  • Anticoagulants/therapeutic use
  • Atrial Fibrillation/complications
  • COVID-19/epidemiology
  • Cohort Studies
  • Humans
  • SARS-CoV-2
  • Stroke/drug therapy

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