Cornelia Gheaa, Ardyan Wardhanab*, Alfredo Nugrohoc, Fika Humaeda Assilmid
aDepartment of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia, bDepartment of Clinical Medicine, Faculty of Medicine, Universitas Surabaya, Surabaya, Indonesia, cKlinik Lombok 25, Surabaya, Indonesia, dSchool of Medicine, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
Abstract
Objectives: Anticoagulants have been used as therapeutic or prophylactic agents in COVID‑19 and seem to be more beneficial. However, the advantage of oral anticoagulant (OAC) consumption before visit in lowering mortality in COVID‑19 patients remains debatable. This meta‑analysis aimed to evaluate the effect of OAC use before visit on mortality using the hazard ratio (HR) to estimate the effect of time‑to‑event endpoints. Materials and Methods: We conducted a literature search in the PubMed and ProQuest databases for any studies comparing groups consuming OAC to no‑OAC before visit for mortality in patients with COVID‑19. We calculated the overall HRs and their variances across the studies using the random‑effects model to obtain pooled estimates. Results: We included 12 studies which had sample sizes ranging from 70 to 459,402 patients. A meta‑analysis comparing OAC therapy and non‑OAC consumption in COVID‑19 patients before visit revealed no decrease in all‑cause mortality (HR = 0.92, 95% confidence interval [CI]: 0.83–1.02, P = 0.12; I2 = 68%). However, subgroup analysis of laboratory‑confirmed populations revealed that OAC use before visit had a beneficial effect on mortality (HR = 0.84, 95% CI: 0.73–0.98, P = 0.02; I2 = 56%). Conclusion: The use of OAC before visit had no beneficial effect on all‑cause mortality in COVID‑19 patients.
Keywords: Anticoagulation, COVID‑19, Direct oral anticoagulant, Mortality, Oral anticoagulant
