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Association between oral anticoagulants and COVID-19-related outcomes
This paper investigates the association between OACs and COVID-19 outcomes in those with atrial fibrillation and a CHA2DS2-VASc score of 2.
British Journal of General Practice, 2022
Abstract
Background
Early evidence has shown that anticoagulant reduces the risk of thrombotic events in those infected with COVID-19. However, evidence of the role of routinely prescribed oral anticoagulants (OACs) in COVID-19 outcomes is limited.
Methods
On behalf of NHS England, a population-based cohort study was conducted. The study used primary care data and pseudonymously-linked SARS-CoV-2 antigen testing data, hospital admissions, and death records from England. Cox regression was used to estimate hazard ratios (HRs) for COVID-19 outcomes comparing people with current OAC use versus non-use, accounting for age, sex, comorbidities, other medications, deprivation, and general practice.
Results
Of 71 103 people with atrial fibrillation and a CHA2DS2-VASc score of 2, there were 52 832 current OAC users and 18 271 non-users. No difference in risk of being tested for SARS-CoV-2 was associated with current use (adjusted HR [aHR] 0.99, 95% confidence interval [CI] = 0.95 to 1.04) versus non-use. A lower risk of testing positive for SARS-CoV-2 (aHR 0.77, 95% CI = 0.63 to 0.95) and a marginally lower risk of COVID-19-related death (aHR, 0.74, 95% CI = 0.53 to 1.04) were associated with current use versus non-use.
Conclusions
Among those at low baseline stroke risk, people receiving OACs had a lower risk of testing positive for SARS-CoV-2 and severe COVID-19 outcomes than non-users; this might be explained by a causal effect of OACs in preventing severe COVID-19 outcomes or unmeasured confounding, including more cautious behaviours leading to reduced infection risk.
- Angel Wong,
- Laurie Tomlinson,
- Jeremy Brown,
- William Elson,
- Alex Walker,
- Anna Schultze,
- Caroline Morton,
- Dave Evans,
- Peter Inglesby,
- Brian MacKenna,
- Krishnan Bhaskaran,
- Christopher Rentsch,
- Emma Powell,
- Elizabeth Williamson,
- Richard Croker,
- Seb Bacon,
- Will Hulme,
- Chris Bates,
- Helen Curtis,
- Amir Mehrkar,
- Jonathan Cockburn,
- Helen McDonald,
- Rohini Mathur,
- Kevin Wing,
- Harriet Forbes,
- Rosalind Eggo,
- Stephen Evans,
- Liam Smeeth,
- Ben Goldacre,
- Ian Douglas