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Stability of vitamin K antagonist anticoagulation after COVID‐19 diagnosis
BACKGROUND: Coagulopathy has been reported in severely ill patients with coronavirus disease 2019 (COVID‐19). It is unclear whether outpatients with COVID‐19 who are treated with vitamin K antagonists (VKAs) have unstable anticoagulation. OBJECTIVE: To assess the stability of VKA therapy in patients...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8511881/ https://www.ncbi.nlm.nih.gov/pubmed/34667920 http://dx.doi.org/10.1002/rth2.12597 |
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author | Camilleri, Eleonora van Rein, Nienke van der Meer, Felix J. M. Nierman, Melchior C. Lijfering, Willem M. Cannegieter, Suzanne C. |
author_facet | Camilleri, Eleonora van Rein, Nienke van der Meer, Felix J. M. Nierman, Melchior C. Lijfering, Willem M. Cannegieter, Suzanne C. |
author_sort | Camilleri, Eleonora |
collection | PubMed |
description | BACKGROUND: Coagulopathy has been reported in severely ill patients with coronavirus disease 2019 (COVID‐19). It is unclear whether outpatients with COVID‐19 who are treated with vitamin K antagonists (VKAs) have unstable anticoagulation. OBJECTIVE: To assess the stability of VKA therapy in patients with COVID‐19 through a case‐crossover study. METHODS: Between February and July 2020, we included patients who tested positive for COVID‐19 from two anticoagulant clinics in the Netherlands. We collected international normalized ratios (INRs) determined between 26 weeks before infection and 12 weeks after. Time in therapeutic range (TTR) and the variance growth rate (VGR) were calculated within patients. RESULTS: Fifty‐one patients with COVID‐19 (mean age, 84 years) were included, of whom 15 (29%) were men. Mean TTR in the 26 weeks before COVID‐19 was 80% (95% confidence interval [CI], 75‐85) compared to 59% (95% CI, 51‐68) in the 6 weeks after infection. Mean TTR difference was −23% (95% CI, −32 to −14) with a time above therapeutic range of 38% (95% CI, 30‐47) in the 6 weeks after infection. The TTR rose again to 79% (95% CI, 69‐89) between 6 and 12 weeks after infection. Also, VGR increased, with a mean increase of 4.8 (95% CI, 2.1‐7.5) in the 6 weeks after infection. In the 26 weeks before infection, we registered 19 of 641 (3%) of INR ≥5.0 compared with 35 of 247 (14%) in the 6 weeks after (risk ratio, 4.4; 95% CI, 2.7‐7.3). CONCLUSIONS: COVID‐19 is associated with a strong decrease in TTR and in therapeutic stability in patients taking VKAs. Additional monitoring in these patients is advised to maximize therapeutic stability. |
format | Online Article Text |
id | pubmed-8511881 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-85118812021-10-18 Stability of vitamin K antagonist anticoagulation after COVID‐19 diagnosis Camilleri, Eleonora van Rein, Nienke van der Meer, Felix J. M. Nierman, Melchior C. Lijfering, Willem M. Cannegieter, Suzanne C. Res Pract Thromb Haemost Original Articles BACKGROUND: Coagulopathy has been reported in severely ill patients with coronavirus disease 2019 (COVID‐19). It is unclear whether outpatients with COVID‐19 who are treated with vitamin K antagonists (VKAs) have unstable anticoagulation. OBJECTIVE: To assess the stability of VKA therapy in patients with COVID‐19 through a case‐crossover study. METHODS: Between February and July 2020, we included patients who tested positive for COVID‐19 from two anticoagulant clinics in the Netherlands. We collected international normalized ratios (INRs) determined between 26 weeks before infection and 12 weeks after. Time in therapeutic range (TTR) and the variance growth rate (VGR) were calculated within patients. RESULTS: Fifty‐one patients with COVID‐19 (mean age, 84 years) were included, of whom 15 (29%) were men. Mean TTR in the 26 weeks before COVID‐19 was 80% (95% confidence interval [CI], 75‐85) compared to 59% (95% CI, 51‐68) in the 6 weeks after infection. Mean TTR difference was −23% (95% CI, −32 to −14) with a time above therapeutic range of 38% (95% CI, 30‐47) in the 6 weeks after infection. The TTR rose again to 79% (95% CI, 69‐89) between 6 and 12 weeks after infection. Also, VGR increased, with a mean increase of 4.8 (95% CI, 2.1‐7.5) in the 6 weeks after infection. In the 26 weeks before infection, we registered 19 of 641 (3%) of INR ≥5.0 compared with 35 of 247 (14%) in the 6 weeks after (risk ratio, 4.4; 95% CI, 2.7‐7.3). CONCLUSIONS: COVID‐19 is associated with a strong decrease in TTR and in therapeutic stability in patients taking VKAs. Additional monitoring in these patients is advised to maximize therapeutic stability. John Wiley and Sons Inc. 2021-10-13 /pmc/articles/PMC8511881/ /pubmed/34667920 http://dx.doi.org/10.1002/rth2.12597 Text en © 2021 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH). https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Articles Camilleri, Eleonora van Rein, Nienke van der Meer, Felix J. M. Nierman, Melchior C. Lijfering, Willem M. Cannegieter, Suzanne C. Stability of vitamin K antagonist anticoagulation after COVID‐19 diagnosis |
title | Stability of vitamin K antagonist anticoagulation after COVID‐19 diagnosis |
title_full | Stability of vitamin K antagonist anticoagulation after COVID‐19 diagnosis |
title_fullStr | Stability of vitamin K antagonist anticoagulation after COVID‐19 diagnosis |
title_full_unstemmed | Stability of vitamin K antagonist anticoagulation after COVID‐19 diagnosis |
title_short | Stability of vitamin K antagonist anticoagulation after COVID‐19 diagnosis |
title_sort | stability of vitamin k antagonist anticoagulation after covid‐19 diagnosis |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8511881/ https://www.ncbi.nlm.nih.gov/pubmed/34667920 http://dx.doi.org/10.1002/rth2.12597 |
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