RT Journal Article
SR Electronic
T1 Association between oral anticoagulants and COVID-19-related outcomes: a population-based cohort study
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e456
OP e463
DO 10.3399/BJGP.2021.0689
VO 72
IS 720
A1 Angel YS Wong
A1 Laurie Tomlinson
A1 Jeremy P Brown
A1 William Elson
A1 Alex J Walker
A1 Anna Schultze
A1 Caroline E Morton
A1 David Evans
A1 Peter Inglesby
A1 Brian MacKenna
A1 Krishnan Bhaskaran
A1 Christopher T Rentsch
A1 Emma Powell
A1 Elizabeth Williamson
A1 Richard Croker
A1 Seb Bacon
A1 William Hulme
A1 Chris Bates
A1 Helen J Curtis
A1 Amir Mehrkar
A1 Jonathan Cockburn
A1 Helen I McDonald
A1 Rohini Mathur
A1 Kevin Wing
A1 Harriet Forbes
A1 Rosalind M Eggo
A1 Stephen JW Evans
A1 Liam Smeeth
A1 Ben Goldacre
A1 Ian J Douglas
A1 (The OpenSAFELY Collaborative)
YR 2022
UL http://bjgp.org/content/72/720/e456.abstract
AB 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.