Impact of atrial fibrillation and anticoagulation on the risk of death, thromboembolic disease and bleeding in patients with COVID-19: the ACO-VID Registry

Abstract

Objective

To describe the clinical profile, risk of complications and impact of anticoagulation in COVID-19 hospitalized patients, according to the presence of atrial fibrillation (AF).

Methods

Multicenter, retrospective, and observational study that consecutively included patients >55 years admitted with COVID-19 from March to October 2020. In AF patients, anticoagulation was chosen based on clinicians’ judgment. Patients were followed-up for 90 days.

Results

A total of 646 patients were included, of whom 75.2% had AF. Overall, mean age was 75 ± 9.1 years and 62.4% were male. Patients with AF were older and had more comorbidities. The most common anticoagulants used during hospitalization in patients with AF were edoxaban (47.9%), low molecular weight heparin (27.0%), and dabigatran (11.7%) and among patients without AF, these numbers were 0%, 93.8% and 0%. Overall, during the study period (68 ± 3 days), 15.2% of patients died, 8.2% of patients presented a major bleeding and 0.9% had a stroke/systemic embolism. During hospitalization, patients with AF had a higher risk of major bleeding (11.3% vs 0.7%; p < .01), COVID-19-related deaths (18.0% vs 4.5%; p = .02), and all-cause deaths (20.6% vs 5.6%; p = .02). Age (HR 1.5; 95% CI 1.0–2.3) and elevated transaminases (HR 3.5; 95% CI 2.0–6.1) were independently associated with all-cause mortality. AF was independently associated with major bleeding (HR 2.2; 95% CI 1.1–5.3)

Conclusions

Among patients hospitalized with COVID-19, patients with AF were older, had more comorbidities and had a higher risk of major bleeding. Age and elevated transaminases during hospitalization, but not AF nor anticoagulant treatment increased the risk of all-cause death.

Keywords:

• Anticoagulation
• atrial fibrillation
• COVID-19
• direct oral anticoagulant

Transparency

Declaration of funding

Funded by the Fundación para la Formación e Investigación Sanitarias de la Región de Murcia, through an unrestricted grant from Boehringer Ingelheim (BI) Spain.BI had no role in the design, analysis, interpretation and publication of the registry. BI was given the opportunity to review the manuscript for medical and scientific accuracy as it relates to BI substances, as well as intellectual property considerations.

Also funded by the Fundación para la Formación e Investigación Sanitarias de la Región de Murcia, through an unrestricted grant from DaichiiSankyo (DS) Spain. DS had no role in the design, analysis, interpretation and publication of the registry.

Declaration of financial/other relationships

The author(s) meet criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE). The authors declare not other conflict of interests related to this article that those state in funding source section. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors contributed extensively to the work presented in this paper. All authors have contributed significantly to the conception, design, or acquisition of data, or analysis and interpretation of data. All authors have participated in drafting, reviewing, and/or revising the manuscript and have approved its submission. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Acknowledgements

Content Ed Net provided medical writing and editorial support, which was funded by the Fundación para la Formación e Investigación Sanitarias de la Región de Murcia.