Wong, Angel Ys; Tomlinson, Laurie; Brown, Jeremy P; Elson, William; Walker, Alex J; Schultze, Anna; Morton, Caroline E; Evans, David; Inglesby, Peter; MacKenna, Brian; +21 more... Bhaskaran, Krishnan; Rentsch, Christopher T; Powell, Emma; Williamson, Elizabeth; Croker, Richard; Bacon, Seb; Hulme, William; Bates, Chris; Curtis, Helen J; Mehrkar, Amir; Cockburn, Jonathan; McDonald, Helen I; Mathur, Rohini; Wing, Kevin; Forbes, Harriet; Eggo, Rosalind M; Evans, Stephen Jw; Smeeth, Liam; Goldacre, Ben; Douglas, Ian J; (The OpenSAFELY Collaborative); (2022) Association between oral anticoagulants and COVID-19-related outcomes: a population-based cohort study. The British journal of general practice : the journal of the Royal College of General Practitioners, 72 (720). e456-e463. ISSN 0960-1643 DOI: https://doi.org/10.3399/BJGP.2021.0689
Permanent Identifier
Use this Digital Object Identifier when citing or linking to this resource.
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. AIM: To investigate the association between OACs and COVID-19 outcomes in those with atrial fibrillation and a CHA2DS2-VASc score of 2. DESIGN AND SETTING: On behalf of NHS England, a population-based cohort study was conducted. METHOD: 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. CONCLUSION: 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.