期刊
JOURNAL OF HEMATOLOGY & ONCOLOGY
卷 14, 期 1, 页码 -出版社
BMC
DOI: 10.1186/s13045-021-01185-0
关键词
Warfarin; Direct oral anticoagulants; COVID-19
资金
- Wellcome Trust - NIHR and Asthma UK-BLF [COV0076, MR/V015737/]
- Longitudinal Health and Wellbeing strand of the National Core Studies programme
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre
- NIHR Applied Research Collaboration Oxford
- NHS England
- Health Foundation
- Wellcome, MRC
- British Council
- British Heart Foundation
- Diabetes UK
- BHF - GSK
- GSK - Wellcome
- Royal Society - NIHR Health Protection Research Unit in Immunisation
- Public Health England
- LSHTM
- Sir Henry Wellcome fellowship
- MRC
- NIHR
- GSK
- Wellcome
This study found a lower risk of COVID-19-related outcomes in patients with non-valvular atrial fibrillation who were using warfarin compared to direct oral anticoagulants (DOACs). Additionally, the study also observed a lower risk of negative control outcomes associated with warfarin.
Background Thromboembolism has been reported as a consequence of severe COVID-19. Although warfarin is a commonly used anticoagulant, it acts by antagonising vitamin K, which is low in patients with severe COVID-19. To date, the clinical evidence on the impact of regular use of warfarin on COVID-19-related thromboembolism is lacking. Methods On behalf of NHS England, we conducted a population-based cohort study investigating the association between warfarin and COVID-19 outcomes compared with direct oral anticoagulants (DOACs). We used the OpenSAFELY platform to analyse primary care data and pseudonymously linked SARS-CoV-2 antigen testing data, hospital admissions and death records from England. We used Cox regression to estimate hazard ratios (HRs) for COVID-19-related outcomes comparing warfarin with DOACs in people with non-valvular atrial fibrillation. We also conducted negative control outcome analyses (being tested for SARS-CoV-2 and non-COVID-19 death) to assess the potential impact of confounding. Results A total of 92,339 warfarin users and 280,407 DOAC users were included. We observed a lower risk of all outcomes associated with warfarin versus DOACs [testing positive for SARS-CoV-2, HR 0.73 (95% CI 0.68-0.79); COVID-19-related hospital admission, HR 0.75 (95% CI 0.68-0.83); COVID-19-related deaths, HR 0.74 (95% CI 0.66-0.83)]. A lower risk of negative control outcomes associated with warfarin versus DOACs was also observed [being tested for SARS-CoV-2, HR 0.80 (95% CI 0.79-0.81); non-COVID-19 deaths, HR 0.79 (95% CI 0.76-0.83)]. Conclusions Overall, this study shows no evidence of harmful effects of warfarin on severe COVID-19 disease.
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