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      Direct oral anticoagulant use and risk of severe COVID‐19

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          Abstract

          Background

          Hypercoagulability and thromboembolism are prominent features of severe COVID‐19, and ongoing anticoagulant use might be protective.

          Methods

          We conducted a nationwide register‐based cohort study in Sweden, February through May, 2020, to assess whether ongoing direct oral anticoagulant (DOAC) use was associated with reduced risk of hospital admission for laboratory‐confirmed COVID‐19, or a composite of intensive care unit (ICU) admission or death due to laboratory‐confirmed COVID‐19.

          Results

          DOAC use ( n = 103 703) was not associated with reduced risk of hospital admission for COVID‐19 (adjusted hazard ratio [aHR] [95% confidence interval] 1.00 [0.75–1.33] vs. nonuse atrial fibrillation comparator [ n = 36 875]; and aHR 0.94 [0.80–1.10] vs. nonuse cardiovascular disease comparator [ n = 355 699]), or ICU admission or death due to COVID‐19 (aHRs 0.76 [0.51–1.12], and 0.90 [0.71–1.15], respectively).

          Conclusion

          Ongoing DOAC use was not associated with reduced risk of severe COVID‐19, indicating that prognosis would not be modified by early outpatient DOAC initiation.

          Abstract

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          Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19

          Maximilian Ackermann, Stijn Verleden, Mark Kuehnel … (2020)
          Progressive respiratory failure is the primary cause of death in the coronavirus disease 2019 (Covid-19) pandemic. Despite widespread interest in the pathophysiology of the disease, relatively little is known about the associated morphologic and molecular changes in the peripheral lung of patients who die from Covid-19.
          Article 0 comments Cited 2833 times – based on 0 reviews     Review now
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            COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-up

            Behnood Bikdeli, Mahesh Madhavan, David Jiménez … (2020)
            Coronavirus disease 2019 (COVID-19), a viral respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may predispose patients to thrombotic disease, both in the venous and arterial circulations, due to excessive inflammation, platelet activation, endothelial dysfunction, and stasis. In addition, many patients receiving antithrombotic therapy for thrombotic disease may develop COVID-19, which can have implications for choice, dosing, and laboratory monitoring of antithrombotic therapy. Moreover, during a time with much focus on COVID-19, it is critical to consider how to optimize the available technology to care for patients without COVID-19 who have thrombotic disease. Herein, we review the current understanding of the pathogenesis, epidemiology, management and outcomes of patients with COVID-19 who develop venous or arterial thrombosis, and of those with preexisting thrombotic disease who develop COVID-19, or those who need prevention or care for their thrombotic disease during the COVID-19 pandemic.
            Article 0 comments Cited 1526 times – based on 0 reviews     Review now
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              Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy

              Corrado Lodigiani, Giacomo Iapichino, Luca Carenzo … (2020)
              Background Few data are available on the rate and characteristics of thromboembolic complications in hospitalized patients with COVID-19. Methods We studied consecutive symptomatic patients with laboratory-proven COVID-19 admitted to a university hospital in Milan, Italy (13.02.2020–10.04.2020). The primary outcome was any thromboembolic complication, including venous thromboembolism (VTE), ischemic stroke, and acute coronary syndrome (ACS)/myocardial infarction (MI). Secondary outcome was overt disseminated intravascular coagulation (DIC). Results We included 388 patients (median age 66 years, 68% men, 16% requiring intensive care [ICU]). Thromboprophylaxis was used in 100% of ICU patients and 75% of those on the general ward. Thromboembolic events occurred in 28 (7.7% of closed cases; 95%CI 5.4%–11.0%), corresponding to a cumulative rate of 21% (27.6% ICU, 6.6% general ward). Half of the thromboembolic events were diagnosed within 24 h of hospital admission. Forty-four patients underwent VTE imaging tests and VTE was confirmed in 16 (36%). Computed tomography pulmonary angiography (CTPA) was performed in 30 patients, corresponding to 7.7% of total, and pulmonary embolism was confirmed in 10 (33% of CTPA). The rate of ischemic stroke and ACS/MI was 2.5% and 1.1%, respectively. Overt DIC was present in 8 (2.2%) patients. Conclusions The high number of arterial and, in particular, venous thromboembolic events diagnosed within 24 h of admission and the high rate of positive VTE imaging tests among the few COVID-19 patients tested suggest that there is an urgent need to improve specific VTE diagnostic strategies and investigate the efficacy and safety of thromboprophylaxis in ambulatory COVID-19 patients.
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                Author and article information

                Contributors
                B. Flam:
                ORCID: https://orcid.org/0000-0002-7826-1708
                benjamin.flam@ki.se
                Journal
                Journal ID (nlm-ta): J Intern Med
                Journal ID (iso-abbrev): J Intern Med
                Journal ID (doi): 10.1111/(ISSN)1365-2796
                Journal ID (publisher-id): JOIM
                Title: Journal of Internal Medicine
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 0954-6820
                ISSN (Electronic): 1365-2796
                Publication date (Electronic): 19 December 2020
                Electronic Location Identifier: 10.1111/joim.13205
                Affiliations
                [ 1 ] From the Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
                [ 2 ] Section of Anaesthesiology and Intensive Care Medicine Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden
                [ 3 ] Clinical Epidemiology Division Department of Medicine Solna Karolinska Institutet Stockholm Sweden
                [ 4 ] Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden
                [ 5 ] Department of Paediatrics Örebro University Hospital Örebro Sweden
                [ 6 ] Division of Epidemiology and Public Health School of Medicine University of Nottingham Nottingham UK
                [ 7 ] Department of Medicine Columbia University College of Physicians and Surgeons New York NY USA
                [ 8 ] Department of Epidemiology Research Statens Serum Institut Copenhagen Denmark
                Author notes
                [*] [* ] Correspondence: Benjamin Flam, Perioperative Medicine and Intensive Care, Karolinska University Hospital, SE‐171 76 Stockholm, Sweden.

                (e‐mail: benjamin.flam@ 123456ki.se ).

                Author information
                https://orcid.org/0000-0002-7826-1708
                https://orcid.org/0000-0001-7759-0887
                https://orcid.org/0000-0003-1024-5602
                https://orcid.org/0000-0001-8739-7896
                https://orcid.org/0000-0002-2097-8466
                Article
                Publisher ID: JOIM13205
                DOI: 10.1111/joim.13205
                PMC ID: 7753564
                PubMed ID: 33258156
                SO-VID: e8757a49-b875-4217-b32a-ae07e7b3268d
                Copyright © © 2020 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 06 October 2020
                Date revision received : 03 November 2020
                Date accepted : 09 November 2020
                Page count
                Figures: 2, Tables: 2, Pages: 9, Words: 9211
                Funding
                Funded by: Swedish Government Funds for Clinical Research (ALF)
                Funded by: Swedish Research Council
                Funded by: Karolinska Institutet Strategic Research Area Epidemiology program
                Categories
                Subject: Brief Report
                Subject: Brief Reports
                Custom metadata
                source-schema-version-number 2.0
                edited-state corrected-proof
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.6 mode:remove_FC converted:22.12.2020

                ScienceOpen disciplines: Internal medicine
                Keywords: anticoagulants,atrial fibrillation,covid‐19,direct‐acting oral anticoagulants,sars‐cov‐2
                Data availability:
                ScienceOpen disciplines: Internal medicine
                Keywords: anticoagulants, atrial fibrillation, covid‐19, direct‐acting oral anticoagulants, sars‐cov‐2

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