Division of Clinical Pharmacy, University of California San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, 9500 Gilman Dr, Room 2244, La Jolla, CA, 92093, USA.
Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA.
Am J Cardiovasc Drugs. 2024 Sep;24(5):693-702. doi: 10.1007/s40256-024-00671-3. Epub 2024 Aug 13.
Coronavirus disease 2019 (COVID-19) has been associated with an increased risk of stroke. It remains unclear whether the risk of stroke associated with a diagnosis of COVID-19 differed with oral anticoagulation (OAC) use. The aim of this study was to evaluate the association between COVID-19 infection, OAC use, and stroke in patients with atrial fibrillation (AF).
A retrospective cohort study was conducted in individuals with established AF using data from Optum's deidentified Clinformatics Data Mart Database. Cox proportional hazard models with time-dependent variables were employed to assess the association between possession of OAC, COVID-19 diagnosis in both inpatient and outpatient setting, and time to ischemic stroke.
A total of 561,758 individuals aged 77 ± 10 were included in the study, with a mean follow up time of 1.3 years. OAC use was associated with a reduced stroke risk [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.82-0.88]. COVID-19 infection was associated with an increased risk of stroke (HR 2.11, 95% CI 1.87-2.38); this increased risk was particularly pronounced for patients diagnosed with an inpatient diagnosis of COVID-19 (HR 3.95, 95% CI 3.33-4.68). There was no significant interaction between OAC use and COVID-19 diagnosis (p value = 0.96). As a result, the relative increase in stroke risk associated with COVID-19 did not differ between patients on OAC (HR 2.12; 95% CI 1.71-2.62) and those not on OAC (HR 2.11; 95% CI 1.83-2.43).
In a nationwide sample of patients with established AF, we found the relative increase in stroke risk associated with COVID-19 was independent of OAC use.
新型冠状病毒疾病 2019（COVID-19）与中风风险增加有关。目前尚不清楚 COVID-19 诊断与口服抗凝剂（OAC）使用相关的中风风险是否不同。本研究旨在评估 COVID-19 感染、OAC 使用与心房颤动（AF）患者中风之间的关系。
使用 Optum 匿名 Clinformatics Data Mart 数据库中的数据，对已确诊 AF 的个体进行回顾性队列研究。采用时变变量的 Cox 比例风险模型评估 OAC 拥有、门诊和住院环境中 COVID-19 诊断与缺血性中风时间之间的关系。
共纳入 561758 名年龄 77 ± 10 岁的患者，平均随访时间为 1.3 年。OAC 使用与中风风险降低相关（风险比[HR]0.85，95%置信区间[CI]0.82-0.88）。COVID-19 感染与中风风险增加相关（HR 2.11，95%CI 1.87-2.38）；住院 COVID-19 诊断患者的这种风险增加尤其明显（HR 3.95，95%CI 3.33-4.68）。OAC 使用与 COVID-19 诊断之间无显著交互作用（p 值=0.96）。因此，与 COVID-19 相关的中风风险增加与 OAC 使用无关（HR 2.12；95%CI 1.71-2.62）和未使用 OAC 的患者（HR 2.11；95%CI 1.83-2.43）。
在一项全国性的已确诊 AF 患者样本中，我们发现与 COVID-19 相关的中风风险的相对增加与 OAC 使用无关。
