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 language | English |
|---|---|
| Pages (from-to) | e456-e463 |
| Journal | British Journal of General Practice |
| Volume | 72 |
| Issue number | 720 |
| DOIs | |
| Publication status | Published - 30 Jun 2022 |
| Externally published | Yes |
Bibliographical note
Publisher Copyright:© 2022 Royal College of General Practitioners. All rights reserved.
Funding
The OpenSAFELY data science platform is funded by the Wellcome Trust. OpenSAFELY work was jointly funded by UKRI [COV0076;MR/V015737/1], NIHR and Asthma UK-BLF and the Longitudinal Health and Wellbeing strand of the National Core Studies programme. TPP provided technical expertise and infrastructure within their data centre pro bono in the context of a national emergency. Ben Goldacre’s work on better use of data in healthcare more broadly is currently funded in part by: National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, NIHR Applied Research Collaboration Oxford and Thames Valley, the Mohn-Westlake Foundation, NHS England, and the Health Foundation; all DataLab staff are supported by Ben Goldacre’s grants on this work. Liam Smeeth reports grants from Wellcome, Medical Research Council (MRC), NIHR, UK Research and Innovation (UKRI), British Council, GlaxoSmithKline (GSK), British Heart Foundation (BHF), and Diabetes UK outside this work. Angel YS Wong holds a fellowship from BHF. Jeremy P Brown is funded by a studentship from GSK. Anna Schultze is employed by the London School of Hygiene and Tropical Medicine (LSHTM) on a fellowship sponsored by GSK. Krishnan Bhaskaran holds a Sir Henry Dale fellowship jointly funded by Wellcome and the Royal Society (107731/Z/15/Z). Helen I McDonald is funded by the NIHR Health Protection Research Unit in Immunisation, a partnership between Public Health England and LSHTM. Rohini Mathur holds a Sir Henry Wellcome fellowship. Elizabeth Williamson holds grants from MRC. Ian J Douglas holds grants from NIHR and GSK. Harriet Forbes holds a UKRI fellowship. The views expressed are those of the authors and not necessarily those of the NIHR, NHS England, Public Health England or the Department of Health and Social Care. Funders had no role in the study design, collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. All authors have completed the ICMJE uniform disclosure form at www.icmje.org/ coi_disclosure.pdf and declare the following: Ben Goldacre has received research funding from Health Data Research UK (HDRUK), the Laura and John Arnold Foundation, the Wellcome Trust, the NIHR Oxford Biomedical Research Centre, the NHS National Institute for Health Research School of Primary Care Research, the Mohn-Westlake Foundation, the Good Thinking Foundation, the Health Foundation, and the World Health Organization; he also receives personal income from speaking and writing for lay audiences on the misuse of science. Ian J Douglas has received unrestricted research grants and holds shares in GlaxoSmithKline. All other authors have declared no competing interests.
| Funders | Funder number |
|---|---|
| Asthma UK-BLF | |
| Good Thinking Foundation | |
| Health Data Research UK | |
| NHS National Institute for Health Research School of Primary Care Research | |
| NIHR Applied Research Collaboration Oxford | |
| Thames Valley | |
| GlaxoSmithKline | |
| World Health Organization | |
| London School of Hygiene and Tropical Medicine | |
| Laura and John Arnold Foundation | |
| Wellcome Trust | MR/V015737/1, COV0076 |
| Heart of England NHS Foundation Trust | |
| UK Research and Innovation | |
| Medical Research Council | |
| National Institute for Health and Care Research | |
| British Heart Foundation | |
| Royal Society | 107731/Z/15/Z |
| British Council | |
| Diabetes UK | |
| Health Foundation | |
| Public Health England | |
| NIHR Oxford Biomedical Research Centre | |
| Mohn Westlake Foundation |
Keywords
- Administration, Oral
- Anticoagulants/therapeutic use
- Atrial Fibrillation/complications
- COVID-19/epidemiology
- Cohort Studies
- Humans
- SARS-CoV-2
- Stroke/drug therapy
- COVID-19
- Factor Xa Inhibitors
- dabigatran
- warfarin
ASJC Scopus subject areas
- Family Practice
