Rivera-Caravaca José Miguel, Frost Freddy, Marín Francisco, Lip Gregory Y H
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK.
Faculty of Nursing, University of Murcia, Murcia, Spain.
Eur J Clin Invest. 2024 Dec;54(12):e14299. doi: 10.1111/eci.14299. Epub 2024 Aug 6.
The impact of chronic oral anticoagulant (OACs) use on long-term post-discharge outcomes after coronavirus disease 2019 (COVID-19) hospitalisation remains unclear. Herein, we compared clinical outcomes up to 2-years after COVID-19 hospitalisation between patients on vitamin K antagonists (VKAs), direct-acting OACs (DOACs) and no OAC therapy.
Data from TriNetX, a global federated health research network, were used. Adult patients on VKAs, DOACs or no OAC therapy at diagnosis of COVID-19 between 20 January 2020 and 31 December 2021, who were hospitalised for COVID-19, were included. The primary outcomes were all-cause mortality, ischaemic stroke/transient ischaemic attack (TIA)/systemic embolism (SE) and the composite of intracranial haemorrhage (ICH)/gastrointestinal bleeding, at 2 years after COVID-19 hospitalisation.
We included 110,834 patients with COVID-19. Following propensity score matching (PSM), we identified a decreased mortality risk in DOAC-treated patients compared to the no OAC cohort (RR .808, 95% CI .751-.870). A higher risk of ischaemic stroke/TIA/SE was observed in VKA users compared to DOAC users (RR 1.100, 95% CI 1.020-1.220) and in VKA users compared to patients not taking OAC (RR 1.400, 95% CI 1.140-1.720). VKA use was associated with a greater risk of ICH/gastrointestinal bleeding than DOAC users (RR 1.198, 95% CI 1.066-1.347), while DOAC users had a lower risk compared to no OAC-treated patients (RR .840, 95% CI .754-.936).
COVID-19 patients taking prior DOACs were associated with lower long-term mortality risk and ICH/gastrointestinal bleeding than patients not taking OAC. Compared to patients on DOACs, VKA users were associated with higher risks of mortality, ischaemic stroke/TIA/SE and ICH/gastrointestinal bleeding.
长期口服抗凝剂（OACs）的使用对2019冠状病毒病（COVID-19）住院后的长期出院后结局的影响尚不清楚。在此，我们比较了维生素K拮抗剂（VKAs）、直接作用口服抗凝剂（DOACs）使用者与未接受OAC治疗的患者在COVID-19住院后长达2年的临床结局。
使用来自全球联合健康研究网络TriNetX的数据。纳入2020年1月20日至2021年12月31日期间诊断为COVID-19时接受VKAs、DOACs治疗或未接受OAC治疗且因COVID-19住院的成年患者。主要结局是COVID-19住院2年后的全因死亡率、缺血性中风/短暂性脑缺血发作（TIA）/全身性栓塞（SE）以及颅内出血（ICH）/胃肠道出血的复合结局。
我们纳入了110,834例COVID-19患者。经过倾向评分匹配（PSM）后，我们发现与未接受OAC治疗的队列相比，接受DOAC治疗的患者死亡风险降低（风险比[RR]0.808，95%置信区间[CI]0.751 - 0.870）。与DOAC使用者相比，VKA使用者发生缺血性中风/TIA/SE的风险更高（RR 1.100，95% CI 1.020 - 1.220），与未服用OAC的患者相比，VKA使用者发生缺血性中风/TIA/SE的风险也更高（RR 1.400，95% CI 1.140 - 1.720）。与DOAC使用者相比，使用VKA发生ICH/胃肠道出血的风险更高（RR 1.198，95% CI 1.066 - 1.347），而与未接受OAC治疗的患者相比，DOAC使用者的风险更低（RR 0.840，95% CI 0.754 - 0.936）。
与未接受OAC治疗的患者相比，服用过DOAC的COVID-19患者长期死亡风险和ICH/胃肠道出血风险更低。与DOAC使用者相比，VKA使用者的死亡、缺血性中风/TIA/SE和ICH/胃肠道出血风险更高。
