先前口服抗凝疗法对 COVID-19 出院后疗效的影响:全球联合医疗网络分析结果。

IF 4.4 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL European Journal of Clinical Investigation Pub Date : 2024-08-06 DOI:10.1111/eci.14299
José Miguel Rivera-Caravaca, Freddy Frost, Francisco Marín, Gregory Y. H. Lip
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引用次数: 0

摘要

背景:慢性口服抗凝剂(OACs)的使用对2019年冠状病毒病(COVID-19)住院后出院后长期预后的影响仍不清楚。在此,我们比较了接受维生素K拮抗剂(VKA)、直接作用口服抗凝剂(DOAC)治疗和未接受OAC治疗的患者在COVID-19住院后长达2年的临床预后:方法:使用全球联合健康研究网络 TriNetX 的数据。纳入了 2020 年 1 月 20 日至 2021 年 12 月 31 日期间确诊 COVID-19 时正在使用 VKA、DOAC 或无 OAC 治疗的成人患者,这些患者因 COVID-19 住院。主要结果为COVID-19住院2年后的全因死亡率、缺血性卒中/短暂性脑缺血发作(TIA)/系统性栓塞(SE)以及颅内出血(ICH)/消化道出血的综合结果:我们纳入了 110,834 名 COVID-19 患者。经过倾向评分匹配 (PSM),我们发现与不使用 OAC 的队列相比,使用 DOAC 治疗的患者的死亡风险降低(RR .808, 95% CI .751-.870)。与使用 DOAC 的患者相比,使用 VKA 的患者发生缺血性卒中/TIA/SE 的风险更高(RR 1.100,95% CI 1.020-1.220),与未使用 OAC 的患者相比,使用 VKA 的患者发生缺血性卒中/TIA/SE 的风险更高(RR 1.400,95% CI 1.140-1.720)。与使用 DOAC 的患者相比,使用 VKA 的患者发生 ICH/消化道出血的风险更高(RR 1.198,95% CI 1.066-1.347),而与未接受 OAC 治疗的患者相比,使用 DOAC 的患者发生 ICH/消化道出血的风险更低(RR 0.840,95% CI 0.754-0.936):结论:与未服用 OAC 的患者相比,曾服用 DOAC 的 COVID-19 患者的长期死亡风险和 ICH/消化道出血风险较低。与服用 DOACs 的患者相比,VKA 使用者的死亡率、缺血性中风/TIA/SE 和 ICH/消化道出血风险更高。
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Impact of prior oral anticoagulation therapies on post-discharge outcomes after COVID-19: Results from a global federated health network analysis

Background

The impact of chronic oral anticoagulant (OACs) use on long-term post-discharge outcomes after coronavirus disease 2019 (COVID-19) hospitalisation remains unclear. Herein, we compared clinical outcomes up to 2-years after COVID-19 hospitalisation between patients on vitamin K antagonists (VKAs), direct-acting OACs (DOACs) and no OAC therapy.

Methods

Data from TriNetX, a global federated health research network, were used. Adult patients on VKAs, DOACs or no OAC therapy at diagnosis of COVID-19 between 20 January 2020 and 31 December 2021, who were hospitalised for COVID-19, were included. The primary outcomes were all-cause mortality, ischaemic stroke/transient ischaemic attack (TIA)/systemic embolism (SE) and the composite of intracranial haemorrhage (ICH)/gastrointestinal bleeding, at 2 years after COVID-19 hospitalisation.

Results

We included 110,834 patients with COVID-19. Following propensity score matching (PSM), we identified a decreased mortality risk in DOAC-treated patients compared to the no OAC cohort (RR .808, 95% CI .751–.870). A higher risk of ischaemic stroke/TIA/SE was observed in VKA users compared to DOAC users (RR 1.100, 95% CI 1.020–1.220) and in VKA users compared to patients not taking OAC (RR 1.400, 95% CI 1.140–1.720). VKA use was associated with a greater risk of ICH/gastrointestinal bleeding than DOAC users (RR 1.198, 95% CI 1.066–1.347), while DOAC users had a lower risk compared to no OAC-treated patients (RR .840, 95% CI .754–.936).

Conclusion

COVID-19 patients taking prior DOACs were associated with lower long-term mortality risk and ICH/gastrointestinal bleeding than patients not taking OAC. Compared to patients on DOACs, VKA users were associated with higher risks of mortality, ischaemic stroke/TIA/SE and ICH/gastrointestinal bleeding.

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期刊介绍: EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.
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