Rubini-Costa Ricardo, Bermúdez-Jiménez Francisco, Rivera-López Ricardo, Sola-García Elena, Nagib-Raya Hadi, Moreno-Escobar Eduardo, López-Zúñiga Miguel Ángel, Briones-Través Adela, Sanz-Herrera Francisco, Sequí-Sabater Jose Miguel, Romero-Cabrera Juan Luis, Maíllo-Seco Javier, Fernández-Vázquez Felipe, Rivadeneira-Ruiz María, López-Valero Lucas, Gómez-Navarro Carlos, Aparicio-Gómez Jose Antonio, López Miguel Álvarez, Tercedor Luis, Molina-Jiménez María, Macías-Ruiz Rosa, Jiménez-Jáimez Juan
Servicio de Cardiología, Hospital General Universitario Virgen de las Nieves, Avda. de las Fuerzas Armadas 2, 18014 Granada, Spain.
Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain.
Med Clin (Engl Ed). 2022 Jun 24;158(12):569-575. doi: 10.1016/j.medcle.2021.06.026. Epub 2022 Jun 22.
Atrial fibrillation (AF) is common in patients admitted with severe COVID-19. However, there is limited data about the management of chronic anticoagulation therapy in these patients. We assessed the anticoagulation and incidence of major cardiovascular events in hospitalized patients with AF and COVID-19.
We retrospectively investigated all consecutive patients with AF admitted with COVID-19 between March and May 2020 in 9 Spanish hospitals. We selected a control group of non-AF patients consecutively admitted with COVID-19. We compared baseline characteristics, incidence of major bleeding, thrombotic events and mortality. We used propensity score matching (PSM) to minimize potential confounding variables, as well as a multivariate analysis to predict major bleeding and death.
305 patients admitted with AF and COVID-19 were included. After PSM, 151 AF patients were matched with 151 control group patients. During admission, low-molecular-weight heparin was the principal anticoagulant and the incidence of major bleeding and mortality were higher in the AF group [16 (10.6%) vs 3 (2%), = 0.003; 52 (34.4%) vs 35 (23.2%), = 0.03, respectively]. The multivariate analysis showed the presence of AF as independent predictor of in-hospital major bleeding and mortality in COVID-19 patients. In AF group, a secondary multivariate analysis identified high levels of D-dimer as independent predictor of in-hospital major bleeding.
AF patients admitted with COVID-19 represent a population at high risk for bleeding and mortality during admission. It seems advisable to individualize anticoagulation therapy during admission, considering patient specific bleeding and thrombotic risk.
心房颤动（AF）在因重症新型冠状病毒肺炎（COVID-19）入院的患者中很常见。然而，关于这些患者慢性抗凝治疗管理的数据有限。我们评估了住院的AF合并COVID-19患者的抗凝情况及主要心血管事件的发生率。
我们回顾性调查了2020年3月至5月期间西班牙9家医院收治的所有连续的AF合并COVID-19患者。我们选取了连续收治的非AF合并COVID-19患者作为对照组。我们比较了基线特征、大出血、血栓形成事件和死亡率的发生率。我们使用倾向评分匹配（PSM）来尽量减少潜在的混杂变量，并进行多变量分析以预测大出血和死亡情况。
纳入了305例AF合并COVID-19患者。经过PSM后，151例AF患者与151例对照组患者匹配。住院期间，低分子量肝素是主要的抗凝剂，AF组的大出血发生率和死亡率更高[分别为16例（10.6%）对3例（2%），P = 0.003；52例（34.4%）对35例（23.2%），P = 0.03]。多变量分析显示，AF的存在是COVID-19患者院内大出血和死亡的独立预测因素。在AF组中，二次多变量分析确定D-二聚体水平升高是院内大出血的独立预测因素。
AF合并COVID-19的住院患者在住院期间出血和死亡风险较高。考虑到患者具体的出血和血栓形成风险，住院期间个体化抗凝治疗似乎是可取的。
