Preadmission Oral Anticoagulation for Atrial Fibrillation/Flutter and Death or Thrombotic Events During COVID-19 Admission

Authors

David W. Louis
Kevin F. Kennedy
Marwan Saad
Greg Salber
Hafiz Imran
Tyler Wark
Cullen Soares
Dhairyasheel Ghosalkar
Rasan Cherala
Athena Poppas
J. Dawn Abbott
Herbert D. Aronow, Henry Ford HealthFollow

Recommended Citation

Louis DW, Kennedy KF, Saad M, Salber G, Imran H, Wark T, Soares C, Ghosalkar D, Cherala R, Poppas A, Abbott JD, and Aronow HD. Preadmission Oral Anticoagulation for Atrial Fibrillation/Flutter and Death or Thrombotic Events During COVID-19 Admission. Am J Cardiol 2022.

Document Type

Article

Publication Date

10-15-2022

Publication Title

The American journal of cardiology

Abstract

Atrial fibrillation/flutter (AF) and COVID-19 are associated with an elevated risk of arterial and venous thrombosis. Whether preadmission oral anticoagulation (OAC) for AF reduces the incidence of in-hospital death or thrombotic events among patients with COVID-19 is unknown. We identified 630 patients with pre-existing AF and a hospitalization diagnosis of COVID-19 and stratified them according to preadmission OAC use. Multivariable logistic regression was employed to relate preadmission OAC to composite in-hospital mortality or thrombotic events. Unadjusted composite in-hospital mortality or thrombotic complications occurred less often in those on than not on preadmission OAC (27.1% vs 46.8%, p <0.001). After adjustment, the incidence of composite in-hospital all-cause mortality or thrombotic complications remained lower with preadmission OAC (odds ratio 0.37, confidence interval 0.25 to 0.53, p <0.0001). Secondary outcomes including all-cause mortality (16.3% vs 24.9%, p = 0.007), intensive care unit admission (14.7% vs 29.0%, p <0.001), intubation (6.4% vs 18.6%, p <0.001), and noninvasive ventilation (18.6% vs 27.5%, p = 0.007) occurred less frequently, and length of stay was shorter (6 vs 7 days, p <0.001) in patients on than those not on preadmission OAC. A higher CHA(2)DS(2)-VASc score was associated with an increased risk of thrombotic events. In conclusion, among patients with baseline AF who were hospitalized with COVID-19, those on preadmission OAC had lower rates of death, arterial and venous thrombotic events, and less severe COVID-19.

Medical Subject Headings

Administration, Oral; Anticoagulants; Atrial Fibrillation; Atrial Flutter; COVID-19; Hospital Mortality; Hospitalization; Humans; Risk Assessment; Risk Factors; Stroke; Thrombosis

PubMed ID

35970632

ePublication

ePub ahead of print

Volume

181

First Page

38

Last Page

44