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Prevalence of bleeding secondary to anticoagulation and mortality in patients with atrial fibrillation admitted with SARS-CoV-2 infection
INTRODUCTION AND PURPOSE: Atrial fibrillation (AF) is common in patients admitted with severe COVID-19. However, there is limited data about the management of chronic anticoagulation therapy in these patients. We assessed the anticoagulation and incidence of major cardiovascular events in hospitaliz...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier España, S.L.U.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8279935/ https://www.ncbi.nlm.nih.gov/pubmed/34364707 http://dx.doi.org/10.1016/j.medcli.2021.06.015 |
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author | Rubini-Costa, Ricardo Bermúdez-Jiménez, Francisco Rivera-López, Ricardo Sola-García, Elena Nagib-Raya, Hadi Moreno-Escobar, Eduardo López-Zúñiga, Miguel Ángel Briones-Través, Adela Sanz-Herrera, Francisco Sequí-Sabater, Jose Miguel Romero-Cabrera, Juan Luis Maíllo-Seco, Javier Fernández-Vázquez, Felipe Rivadeneira-Ruiz, María López-Valero, Lucas Gómez-Navarro, Carlos Aparicio-Gómez, Jose Antonio López, Miguel Álvarez Tercedor, Luis Molina-Jiménez, María Macías-Ruiz, Rosa Jiménez-Jáimez, Juan |
author_facet | Rubini-Costa, Ricardo Bermúdez-Jiménez, Francisco Rivera-López, Ricardo Sola-García, Elena Nagib-Raya, Hadi Moreno-Escobar, Eduardo López-Zúñiga, Miguel Ángel Briones-Través, Adela Sanz-Herrera, Francisco Sequí-Sabater, Jose Miguel Romero-Cabrera, Juan Luis Maíllo-Seco, Javier Fernández-Vázquez, Felipe Rivadeneira-Ruiz, María López-Valero, Lucas Gómez-Navarro, Carlos Aparicio-Gómez, Jose Antonio López, Miguel Álvarez Tercedor, Luis Molina-Jiménez, María Macías-Ruiz, Rosa Jiménez-Jáimez, Juan |
author_sort | Rubini-Costa, Ricardo |
collection | PubMed |
description | INTRODUCTION AND PURPOSE: Atrial fibrillation (AF) is common in patients admitted with severe COVID-19. However, there is limited data about the management of chronic anticoagulation therapy in these patients. We assessed the anticoagulation and incidence of major cardiovascular events in hospitalized patients with AF and COVID-19. METHODS: We retrospectively investigated all consecutive patients with AF admitted with COVID-19 between March and May 2020 in 9 Spanish hospitals. We selected a control group of non-AF patients consecutively admitted with COVID-19. We compared baseline characteristics, incidence of major bleeding, thrombotic events and mortality. We used propensity score matching (PSM) to minimize potential confounding variables, as well as a multivariate analysis to predict major bleeding and death. RESULTS: 305 patients admitted with AF and COVID-19 were included. After PSM, 151 AF patients were matched with 151 control group patients. During admission, low-molecular-weight heparin was the principal anticoagulant and the incidence of major bleeding and mortality were higher in the AF group [16 (10.6%) vs 3 (2%), p = 0.003; 52 (34.4%) vs 35 (23.2%), p = 0.03, respectively]. The multivariate analysis showed the presence of AF as independent predictor of in-hospital major bleeding and mortality in COVID-19 patients. In AF group, a secondary multivariate analysis identified high levels of D-dimer as independent predictor of in-hospital major bleeding. CONCLUSIONS: AF patients admitted with COVID-19 represent a population at high risk for bleeding and mortality during admission. It seems advisable to individualize anticoagulation therapy during admission, considering patient specific bleeding and thrombotic risk. |
format | Online Article Text |
id | pubmed-8279935 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Elsevier España, S.L.U. |
record_format | MEDLINE/PubMed |
spelling | pubmed-82799352021-07-20 Prevalence of bleeding secondary to anticoagulation and mortality in patients with atrial fibrillation admitted with SARS-CoV-2 infection Rubini-Costa, Ricardo Bermúdez-Jiménez, Francisco Rivera-López, Ricardo Sola-García, Elena Nagib-Raya, Hadi Moreno-Escobar, Eduardo López-Zúñiga, Miguel Ángel Briones-Través, Adela Sanz-Herrera, Francisco Sequí-Sabater, Jose Miguel Romero-Cabrera, Juan Luis Maíllo-Seco, Javier Fernández-Vázquez, Felipe Rivadeneira-Ruiz, María López-Valero, Lucas Gómez-Navarro, Carlos Aparicio-Gómez, Jose Antonio López, Miguel Álvarez Tercedor, Luis Molina-Jiménez, María Macías-Ruiz, Rosa Jiménez-Jáimez, Juan Med Clin (Barc) Original Article INTRODUCTION AND PURPOSE: Atrial fibrillation (AF) is common in patients admitted with severe COVID-19. However, there is limited data about the management of chronic anticoagulation therapy in these patients. We assessed the anticoagulation and incidence of major cardiovascular events in hospitalized patients with AF and COVID-19. METHODS: We retrospectively investigated all consecutive patients with AF admitted with COVID-19 between March and May 2020 in 9 Spanish hospitals. We selected a control group of non-AF patients consecutively admitted with COVID-19. We compared baseline characteristics, incidence of major bleeding, thrombotic events and mortality. We used propensity score matching (PSM) to minimize potential confounding variables, as well as a multivariate analysis to predict major bleeding and death. RESULTS: 305 patients admitted with AF and COVID-19 were included. After PSM, 151 AF patients were matched with 151 control group patients. During admission, low-molecular-weight heparin was the principal anticoagulant and the incidence of major bleeding and mortality were higher in the AF group [16 (10.6%) vs 3 (2%), p = 0.003; 52 (34.4%) vs 35 (23.2%), p = 0.03, respectively]. The multivariate analysis showed the presence of AF as independent predictor of in-hospital major bleeding and mortality in COVID-19 patients. In AF group, a secondary multivariate analysis identified high levels of D-dimer as independent predictor of in-hospital major bleeding. CONCLUSIONS: AF patients admitted with COVID-19 represent a population at high risk for bleeding and mortality during admission. It seems advisable to individualize anticoagulation therapy during admission, considering patient specific bleeding and thrombotic risk. Elsevier España, S.L.U. 2022-06-24 2021-07-15 /pmc/articles/PMC8279935/ /pubmed/34364707 http://dx.doi.org/10.1016/j.medcli.2021.06.015 Text en © 2021 Elsevier España, S.L.U. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Original Article Rubini-Costa, Ricardo Bermúdez-Jiménez, Francisco Rivera-López, Ricardo Sola-García, Elena Nagib-Raya, Hadi Moreno-Escobar, Eduardo López-Zúñiga, Miguel Ángel Briones-Través, Adela Sanz-Herrera, Francisco Sequí-Sabater, Jose Miguel Romero-Cabrera, Juan Luis Maíllo-Seco, Javier Fernández-Vázquez, Felipe Rivadeneira-Ruiz, María López-Valero, Lucas Gómez-Navarro, Carlos Aparicio-Gómez, Jose Antonio López, Miguel Álvarez Tercedor, Luis Molina-Jiménez, María Macías-Ruiz, Rosa Jiménez-Jáimez, Juan Prevalence of bleeding secondary to anticoagulation and mortality in patients with atrial fibrillation admitted with SARS-CoV-2 infection |
title | Prevalence of bleeding secondary to anticoagulation and mortality in patients with atrial fibrillation admitted with SARS-CoV-2 infection |
title_full | Prevalence of bleeding secondary to anticoagulation and mortality in patients with atrial fibrillation admitted with SARS-CoV-2 infection |
title_fullStr | Prevalence of bleeding secondary to anticoagulation and mortality in patients with atrial fibrillation admitted with SARS-CoV-2 infection |
title_full_unstemmed | Prevalence of bleeding secondary to anticoagulation and mortality in patients with atrial fibrillation admitted with SARS-CoV-2 infection |
title_short | Prevalence of bleeding secondary to anticoagulation and mortality in patients with atrial fibrillation admitted with SARS-CoV-2 infection |
title_sort | prevalence of bleeding secondary to anticoagulation and mortality in patients with atrial fibrillation admitted with sars-cov-2 infection |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8279935/ https://www.ncbi.nlm.nih.gov/pubmed/34364707 http://dx.doi.org/10.1016/j.medcli.2021.06.015 |
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