The effect of chronic anticoagulation and antiplatelets on COVID-19 infection

Background : Severe acute respiratory syndrome coronavirus -2 caused by the novel coronavirus 2019 (Covid-19) has resulted in a global pandemic. Covid-19 disease is associated with a hypercoagulable state, leading to microvascular and/or macrovascular thrombosis. The role of anticoagulation in Covid-19 is debatable. Aims : To compare outcomes of chronic anticoagulation and/or antiplatelets versus no chronic anticoagulation or antiplatelets in Covid-19 patients. Methods : This is a retrospective cohort study of hospitalized patients with polymerase chain reaction confirmed Covid-19 and over the age of 18 years who presented to the Trinity Health hospitals from March 8, 2020, to May 15, 2020. The exposed group was defined as patients who received chronic anticoagulation (warfarin, direct oral anticoagulant) or antiplatelet therapy or both(for more than one-month duration) for reasons other than Covid-19 disease while control group patients were defined as those who did not receive these therapies prior to admission. The primary outcome of the study is a composite outcome to compare mortality, length of hospital stay, readmission rate, rate of intubation, and length of Intensive-Care-Unit admission. Baseline characteristics and Covid-19 related treatment were compared in both groups (Table 1). The chi-square test and the student's t -test were used to compare the outcome in both groups. Statistical analysis was performed using SPSS version 25. Results : There were 3180 patients who were Covid-19 positive during the study period;452 patients met the inclusion criteria. There were 183 patients in the exposed group and 269 patients in the control group. In the exposed group there was a significantly higher three-months mortality rate (30.6% vs. 16%;P < 0.0005) compared to the control group. There were no significant associations between readmission rate, rate of intubation, length of hospital stay, and length of ICU stay by the group. Conclusions : Our results showed higher mortality in patients on chronic anticoagulation or antiplatelet therapy.