Impact of prior oral anticoagulation therapies on post‐discharge outcomes after COVID‐19: Results from a global federated health network analysis

Background The impact of chronic oral anticoagulant (OACs) use on long‐term post‐discharge outcomes after coronavirus disease 2019 (COVID‐19) hospitalisation remains unclear. Herein, we compared clinical outcomes up to 2‐years after COVID‐19 hospitalisation between patients on vitamin K antagonists (VKAs), direct‐acting OACs (DOACs) and no OAC therapy. Methods Data from TriNetX, a global federated health research network, were used. Adult patients on VKAs, DOACs or no OAC therapy at diagnosis of COVID‐19 between 20 January 2020 and 31 December 2021, who were hospitalised for COVID‐19, were included. The primary outcomes were all‐cause mortality, ischaemic stroke/transient ischaemic attack (TIA)/systemic embolism (SE) and the composite of intracranial haemorrhage (ICH)/gastrointestinal bleeding, at 2 years after COVID‐19 hospitalisation. Results We included 110,834 patients with COVID‐19. Following propensity score matching (PSM), we identified a decreased mortality risk in DOAC‐treated patients compared to the no OAC cohort (RR .808, 95% CI .751–.870). A higher risk of ischaemic stroke/TIA/SE was observed in VKA users compared to DOAC users (RR 1.100, 95% CI 1.020–1.220) and in VKA users compared to patients not taking OAC (RR 1.400, 95% CI 1.140–1.720). VKA use was associated with a greater risk of ICH/gastrointestinal bleeding than DOAC users (RR 1.198, 95% CI 1.066–1.347), while DOAC users had a lower risk compared to no OAC‐treated patients (RR .840, 95% CI .754–.936). Conclusion COVID‐19 patients taking prior DOACs were associated with lower long‐term mortality risk and ICH/gastrointestinal bleeding than patients not taking OAC. Compared to patients on DOACs, VKA users were associated with higher risks of mortality, ischaemic stroke/TIA/SE and ICH/gastrointestinal bleeding. The impact of prior oral anticoagulation (OAC) on long‐term outcomes post COVID‐19 hospitalisation remains unclear. In a global federated health research network and following PSM, COVID‐19 patients taking prior direct‐acting OACs (DOACs), presented lower long‐term mortality risk and intracranial haemorrhage (ICH)/gastrointestinal bleeding than patients not taking OAC, whereas patients on prior vitamin K antagonists (VKAs) had higher risk of stroke. Compared to patients on DOACs, VKAs users suffered higher mortality, stroke and ICH/gastrointestinal bleeding risks.