期刊
THROMBOSIS RESEARCH
卷 211, 期 -, 页码 114-122出版社
PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.thromres.2021.12.010
关键词
SARS-CoV-2; Coronavirus disease 2019 (COVID-19); Anticoagulants; Mortality; Hospitalization
资金
- Sunnybrook Foun-dation [R21HL140381]
- National New Investigator Award from the Heart and Stroke Foundation of Canada [IIR-19-134]
- Heart and Stroke Foundation of Ontario
- VA Geriatric Research Education Clinical Center, Tennessee Valley Healthcare System, National Institutes of Health
- VA
- Pfizer
- Clinician-Scientist Award from the University of Toronto Department of Family and Community Medicine
- Heart and Stroke Foundation of Nova Scotia Endowed Chair in Cardiovascular Outcomes Research
- Jack Tu Chair in Cardiovascular Outcomes Research, Sunnybrook Hospital
- Department of Emergency Services at Sunnybrook Health Sciences
- Sunnybrook Research Institute
For outpatients aged > 65 years, oral anticoagulation at the time of a positive SARS-CoV-2 test was associated with a lower risk of a composite of death or hospitalization within 60 days.
Introduction: Anticoagulation may improve outcomes in patients with COVID-19 when started early in the course of illness. Materials and methods: This was a population-based cohort study using linked administrative datasets of outpatients aged > 65 years old testing positive for SARS-CoV-2 between January 1 and December 31, 2020 in Ontario, Canada. The key exposure was anticoagulation with warfarin or direct oral anticoagulants before COVID-19 diagnosis. We calculated propensity scores and used matching weights (MWs) to reduce baseline differences between anticoagulated and non-anticoagulated patients. The primary outcome was a composite of death or hospitalization within 60 days of a positive SARS-CoV-2 test. We used the Kaplan-Meier method and cumulative incidence functions to estimate risk of the primary and component outcomes at 60 days. Results: We studied 23,159 outpatients (mean age 78.5 years; 13,474 [58.2%] female), among whom 3200 (13.8%) deaths and 3183 (13.7%) hospitalizations occurred within 60 days of the SARS-CoV-2 test. After application of MWs, the 60-day risk of death or hospitalization was 29.2% (95% CI 27.4%-31.2%) for anti coagulated individuals and 32.1% (95% CI 30.7%-33.5%) without anticoagulation (absolute risk difference [ARD],-2.9%; p = 0.005). Anticoagulation was also associated with a lower risk of death: 18.6% (95% CI 17.0%-20.2%) with anticoagulation and 20.9% (95% CI 19.7%-22.2%) in non-anticoagulated patients (ARD-2.3%; p = 0.005). Conclusions: Among outpatients aged > 65 years, oral anticoagulation at the time of a positive SARS-CoV-2 test was associated with a lower risk of a composite of death or hospitalization within 60 days.
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