COVID-19 Diagnosis, Oral Anticoagulation, and Stroke Risk in Patients with Atrial Fibrillation

被引:0
作者
Yang, Lanting [1 ]
Tang, Shangbin [1 ]
Guo, Jingchuan [2 ]
Gabriel, Nico [1 ]
Gellad, Walid F. [3 ,4 ]
Essien, Utibe R. [5 ,6 ]
Magnani, Jared W. [7 ]
Hernandez, Inmaculada [1 ]
机构
[1] Univ Calif San Diego, Skaggs Sch Pharm & Pharmaceut Sci, Div Clin Pharm, 9500 Gilman Dr,Room 2244, La Jolla, CA 92093 USA
[2] Univ Florida, Coll Pharm, Dept Pharmaceut Outcomes & Policy, Gainesville, FL USA
[3] Univ Pittsburgh, Sch Med, Div Gen Internal Med, Pittsburgh, PA USA
[4] VA Pittsburgh Healthcare Syst, Ctr Hlth Equ Res & Promot, Pittsburgh, PA USA
[5] Univ Calif Los Angeles, David Geffen Sch Med, Div Gen Internal Med & Hlth Serv Res, Los Angeles, CA USA
[6] Greater Angeles VA Healthcare Syst, Ctr Study Healthcare Innovat Implementat & Policy, Los Angeles, CA USA
[7] Univ Pittsburgh, Sch Med, Dept Med, Div Cardiol, Pittsburgh, PA USA
关键词
MEDICARE BENEFICIARIES; RIVAROXABAN; DABIGATRAN; ADHERENCE; APIXABAN; WARFARIN; SAFETY;
D O I
10.1007/s40256-024-00671-3
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BackgroundCoronavirus disease 2019 (COVID-19) has been associated with an increased risk of stroke. It remains unclear whether the risk of stroke associated with a diagnosis of COVID-19 differed with oral anticoagulation (OAC) use. The aim of this study was to evaluate the association between COVID-19 infection, OAC use, and stroke in patients with atrial fibrillation (AF).MethodsA retrospective cohort study was conducted in individuals with established AF using data from Optum's deidentified Clinformatics (R) Data Mart Database. Cox proportional hazard models with time-dependent variables were employed to assess the association between possession of OAC, COVID-19 diagnosis in both inpatient and outpatient setting, and time to ischemic stroke.ResultsA total of 561,758 individuals aged 77 +/- 10 were included in the study, with a mean follow up time of 1.3 years. OAC use was associated with a reduced stroke risk [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.82-0.88]. COVID-19 infection was associated with an increased risk of stroke (HR 2.11, 95% CI 1.87-2.38); this increased risk was particularly pronounced for patients diagnosed with an inpatient diagnosis of COVID-19 (HR 3.95, 95% CI 3.33-4.68). There was no significant interaction between OAC use and COVID-19 diagnosis (p value = 0.96). As a result, the relative increase in stroke risk associated with COVID-19 did not differ between patients on OAC (HR 2.12; 95% CI 1.71-2.62) and those not on OAC (HR 2.11; 95% CI 1.83-2.43).ConclusionIn a nationwide sample of patients with established AF, we found the relative increase in stroke risk associated with COVID-19 was independent of OAC use.
引用
收藏
页码:693 / 702
页数:10
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