ORIGINAL ARTICLE   

Minerva Medica 2023 October;114(5):628-33

DOI: 10.23736/S0026-4806.22.07797-7

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Chronic anticoagulant treatment and risk of mortality in SARS-Cov2 patients: a large population-based study

Matteo MONTORFANO ¹ ✉, Olivia LEONI ², Aida ANDREASSI ², Monica LUDERGNANI ³, Francesco MORONI ¹, Marco B. ANCONA ¹, Giovanni LANDONI ^{4, 5}, Fabio CICERI ^{5, 6}, Alberto ZANGRILLO ^{4, 5}

¹ Unit of Interventional Cardiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; ² Welfare Directorate, Regione Lombardia, Milan, Italy; ³ ARIA S.p.A, Regione Lombardia, Milan, Italy; ⁴ Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; ⁵ Vita-Salute San Raffaele University, Milan, Italy; ⁶ Unit of Hematology and Bone Marrow Transplant, IRCCS San Raffaele Scientific Institute, Milan, Italy

BACKGROUND: Hypercoagulability is often seen in COVID-19 patients and thromboembolic events appear frequent; antithrombotic treatment has been proposed therefore as part of standard treatment for COVID-19. Under these premises, prior-to-infection antithrombotic treatment may have a protective effect with respect to COVID-19 related thromboembolic events. Aim of the present work was to evaluate the impact of prior-to-infection anticoagulant or antiplatelet treatment on COVID-19 outcomes.
METHODS: Beneficiaries of the Regional Health Service of the Lombardy region of Italy aged ≥40 years with a COVID-19 diagnosis made between February 21^st and July 18^th, 2020 were included in the present study. The impact on COVID-19 mortality of pre-existing and chronic therapy with anticoagulant drugs (vitamin-K antagonist or new oral anticoagulants) was evaluated. Analyses were repeated with antiplatelets drugs.
RESULTS: Among 79,934 SARS-CoV-2 patients beneficiaries of the Regional Healthcare System of the Lombardy Region who received a diagnosis between February 21^st and July 18^th, 2020, chronic pre-existing anticoagulant assumption was present in 6.0% and antiplatelets in 12.7%. The overall unadjusted mortality rate was 20.6%, with male sex, age category and comorbidity burden being significantly associated to increased mortality risk. Anticoagulant chronic treatment was not associated with a reduction in mortality. Similar results were observed when repeating the analyses for pre-existing oral antiplatelet treatment.
CONCLUSIONS: In a large population-based study evaluating more than 79,000 COVID-19 patients, pre-existing antithrombotic therapy was not associated to a benefit in terms of mortality. Further studies are needed to evaluate the role of antithrombotic therapy as standard treatment among COVID-19 patients.

KEY WORDS: COVID-19; Anticoagulants; Therapeutics