TY - JOUR
T1 - Association between oral anticoagulants and COVID-19-related outcomes
T2 - a population-based cohort study
AU - (The OpenSAFELY Collaborative)
AU - Wong, Angel Ys
AU - Tomlinson, Laurie
AU - Brown, Jeremy P
AU - Elson, William
AU - Walker, Alex J
AU - Schultze, Anna
AU - Morton, Caroline E
AU - Evans, David
AU - Inglesby, Peter
AU - MacKenna, Brian
AU - Bhaskaran, Krishnan
AU - Rentsch, Christopher T
AU - Powell, Emma
AU - Williamson, Elizabeth
AU - Croker, Richard
AU - Bacon, Seb
AU - Hulme, William
AU - Bates, Chris
AU - Curtis, Helen J
AU - Mehrkar, Amir
AU - Cockburn, Jonathan
AU - McDonald, Helen I
AU - Mathur, Rohini
AU - Wing, Kevin
AU - Forbes, Harriet
AU - Eggo, Rosalind M
AU - Evans, Stephen Jw
AU - Smeeth, Liam
AU - Goldacre, Ben
AU - Douglas, Ian J
N1 - © The Authors.
PY - 2022/6/30
Y1 - 2022/6/30
N2 - 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.
AB - 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.
KW - Administration, Oral
KW - Anticoagulants/therapeutic use
KW - Atrial Fibrillation/complications
KW - COVID-19/epidemiology
KW - Cohort Studies
KW - Humans
KW - SARS-CoV-2
KW - Stroke/drug therapy
U2 - 10.3399/BJGP.2021.0689
DO - 10.3399/BJGP.2021.0689
M3 - Article
C2 - 35440465
VL - 72
SP - e456-e463
JO - British Journal of General Practice
JF - British Journal of General Practice
SN - 0960-1643
IS - 720
ER -
