Br J Clin Pharmacol: Compared with vitamin K antagonists, the efficacy and safety of direct oral anticoagulants in COVID-19 cardiometabolic disease outpatients

Research Background

Research Background

Oral anticoagulants (OACs), including vitamin K antagonists (VKAs) and direct-acting OACs (DOACs), have been used for thrombosis prevention in different clinical situations
.

In key clinical trials for stroke prevention in atrial fibrillation (AF), DOAC was not inferior to warfarin in preventing stroke/systemic embolism (SE), and compared with warfarin, the incidence of intracranial hemorrhage (ICH) was lower

Studies have shown that COVID-19 can cause endothelial dysfunction, inflammation and hypercoagulability
.

Increased risk of thrombosis and thromboembolic complications are relatively common in these patients, especially those who are hospitalized in the ICU

The purpose of this study was to use the propensity score matching (PSM) method to compare the clinical results of outpatients with cardiometabolic diseases who received chronic VKA or DOAC treatment for 30 days after the diagnosis of COVID-19
.

Research methods

Research methods

A study was conducted using TriNetX, a global federal health research network
.

Adult outpatients with cardiometabolic diseases (ie diabetes and any circulatory diseases) treated with VKA or DOAC after the diagnosis of COVID-19 were included between January 20, 2020 and February 15, 2021

Research result

A total of 2275 patients were enrolled
.

After PSM, 1270 patients remain in the study (635 VKAs; 635 DOACs)

Table 1.
Comparison of clinical characteristics of the study cohort before and after propensity score matching

Table 1.
Comparison of clinical characteristics of study cohort before and after propensity score matching Table 1.
Comparison of clinical characteristics of study cohort before and after propensity score matching

In patients with COVID-19 cardiometabolic disease who have been treated with VKA, the incidence of all end-point events is higher
.

Any arterial or venous thrombotic events (14.

Table 2.
Primary and secondary endpoints of patients using VKA or DOAC

Table 2.
Primary and secondary endpoints of patients using VKA or DOAC Table 2.
Primary and secondary endpoints of patients using VKA or DOAC

In terms of the primary endpoints after PSM, there were no significant differences in the all-cause mortality of patients with VKA or DOACs, the necessity of ICU hospitalization/MV, and the risk of ICH/gastrointestinal bleeding
.

The risk of all-cause death in the VKA cohort and the DOAC cohort was similar (HR 0.

Figure 1.
Survival curve for the primary endpoint

Figure 1.
Survival curve of primary endpoint Figure 1.
Survival curve of primary endpoint

ICU hospitalizations for VKA and DOAC patients were similar (HR 0.
98, 95% CI 0.
50-1.
92)
.

Similarly, the risk of myocardial infarction (HR 1.

Figure 2.

Figure 2.

Analysis conclusion

Among outpatients with COVID-19 cardiometabolic disease, compared with the use of VKA treatment, the use of DOAC treatment has a lower risk of arterial or venous thrombosis and does not increase the risk of bleeding
.

Original source:

Original source:

Douros Antonios et al.
Utilization and long-term persistence of direct oral anticoagulants among patients with non-valvular atrial fibrillation and liver disease .
[J].
British journal of clinical pharmacology, 2021.

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