Early antithrombotic post-discharge therapy using prophylactic DOAC or dipyridamole improves long-term survival and cardiovascular outcomes in hospitalized COVID-19 survivors
IntroductionCardiovascular events are common in COVID-19. While the use of anticoagulation during hospitalization has been established in current guidelines, recommendations regarding antithrombotic therapy in the post-discharge period are conflicting.MethodsTo investigate this issue, we conducted a...
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Frontiers Media S.A.
2022-07-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.916156/full |
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| author | Lukas J. Motloch Peter Jirak Moritz Mirna Lukas Fiedler Lukas Fiedler Paruir A. Davtyan Irina A. Lakman Irina A. Lakman Diana F. Gareeva Anton V. Tyurin Ruslan M. Gumerov Simon T. Matskeplishvili Valentin N. Pavlov Benzhi Cai Kristen Kopp Albert Topf Uta C. Hoppe Rudin Pistulli Naufal S. Zagidullin |
| author_facet | Lukas J. Motloch Peter Jirak Moritz Mirna Lukas Fiedler Lukas Fiedler Paruir A. Davtyan Irina A. Lakman Irina A. Lakman Diana F. Gareeva Anton V. Tyurin Ruslan M. Gumerov Simon T. Matskeplishvili Valentin N. Pavlov Benzhi Cai Kristen Kopp Albert Topf Uta C. Hoppe Rudin Pistulli Naufal S. Zagidullin |
| author_sort | Lukas J. Motloch |
| collection | DOAJ |
| description | IntroductionCardiovascular events are common in COVID-19. While the use of anticoagulation during hospitalization has been established in current guidelines, recommendations regarding antithrombotic therapy in the post-discharge period are conflicting.MethodsTo investigate this issue, we conducted a retrospective follow-up (393 ± 87 days) of 1,746 consecutive patients, hospitalized with and surviving COVID-19 pneumonia at a single tertiary medical center between April and December 2020. Survivors received either 30-day post-discharge antithrombotic treatment regime using prophylactic direct oral anticoagulation (DOAC; n = 1,002) or dipyridamole (n = 304), or, no post-discharge antithrombotic treatment (Ctrl; n = 440). All-cause mortality, as well as cardiovascular mortality (CVM) and further cardiovascular outcomes (CVO) resulting in hospitalization due to pulmonary embolism (PE), myocardial infarction (MI) and stroke were investigated during the follow-up period.ResultsWhile no major bleeding events occured during follow-up in the treatment groups, Ctrl showed a high but evenly distributed rate all-cause mortality. All-cause mortality (CVM) was attenuated by prophylactic DOAC (0.6%, P < 0.001) and dipyridamole (0.7%, P < 0.001). This effect was also evident for both therapies after propensity score analyses using weighted binary logistic regression [DOAC: B = −3.33 (0.60), P < 0.001 and dipyridamole: B = −3.04 (0.76), P < 0.001]. While both treatment groups displayed a reduced rate of CVM [DOAC: B = −2.69 (0.74), P < 0.001 and dipyridamole: B = −17.95 (0.37), P < 0.001], the effect in the DOAC group was driven by reduction of both PE [B−3.12 (1.42), P = 0.012] and stroke [B = −3.08 (1.23), P = 0.028]. Dipyridamole significantly reduced rates of PE alone [B = −17.05 (1.01), P < 0.001].ConclusionLate cardiovascular events and all-cause mortality were high in the year following hospitalization for COVID-19. Application of prophylactic DOAC or dipyridamole in the early post-discharge period improved mid- and long-term CVO and all-cause mortality in COVID-19 survivors. |
| first_indexed | 2024-04-12T08:29:07Z |
| format | Article |
| id | doaj.art-df0ac22d833b4b75bb342820539b4344 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-12T08:29:07Z |
| publishDate | 2022-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-df0ac22d833b4b75bb342820539b43442022-12-22T03:40:16ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-07-01910.3389/fcvm.2022.916156916156Early antithrombotic post-discharge therapy using prophylactic DOAC or dipyridamole improves long-term survival and cardiovascular outcomes in hospitalized COVID-19 survivorsLukas J. Motloch0Peter Jirak1Moritz Mirna2Lukas Fiedler3Lukas Fiedler4Paruir A. Davtyan5Irina A. Lakman6Irina A. Lakman7Diana F. Gareeva8Anton V. Tyurin9Ruslan M. Gumerov10Simon T. Matskeplishvili11Valentin N. Pavlov12Benzhi Cai13Kristen Kopp14Albert Topf15Uta C. Hoppe16Rudin Pistulli17Naufal S. Zagidullin18Clinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, AustriaClinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, AustriaClinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, AustriaClinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, AustriaDepartment of Internal Medicine, Cardiology, Nephrology and Intensive Care Medicine, Hospital Wiener Neustadt, Wiener Neustadt, AustriaDepartment of Internal Medicine I, Bashkir State Medical University, Ufa, RussiaDepartment of Internal Medicine I, Bashkir State Medical University, Ufa, RussiaScientific Laboratory for the Study of Socio-Economic Problems of the Regions Bashkir State University, Ufa, RussiaDepartment of Internal Medicine I, Bashkir State Medical University, Ufa, RussiaDepartment of Internal Diseases II, Bashkir State Medical University, Ufa, RussiaDepartment of Internal Medicine I, Bashkir State Medical University, Ufa, RussiaLomonosov Moscow State University Medical Center, Moscow, RussiaDepartment of Urology, Bashkir State Medical University, Ufa, RussiaDepartment of Pharmacy at The Second Affiliated Hospital, and Department of Pharmacology (The Key Laboratory of Cardiovascular Medicine Research, Ministry of Education) at College of Pharmacy, Harbin Medical University, Harbin, ChinaClinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, AustriaClinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, AustriaClinic II for Internal Medicine, University Hospital Salzburg, Paracelsus Medical University, Salzburg, AustriaDepartment of Cardiology I, Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Munster, Munster, GermanyDepartment of Internal Medicine I, Bashkir State Medical University, Ufa, RussiaIntroductionCardiovascular events are common in COVID-19. While the use of anticoagulation during hospitalization has been established in current guidelines, recommendations regarding antithrombotic therapy in the post-discharge period are conflicting.MethodsTo investigate this issue, we conducted a retrospective follow-up (393 ± 87 days) of 1,746 consecutive patients, hospitalized with and surviving COVID-19 pneumonia at a single tertiary medical center between April and December 2020. Survivors received either 30-day post-discharge antithrombotic treatment regime using prophylactic direct oral anticoagulation (DOAC; n = 1,002) or dipyridamole (n = 304), or, no post-discharge antithrombotic treatment (Ctrl; n = 440). All-cause mortality, as well as cardiovascular mortality (CVM) and further cardiovascular outcomes (CVO) resulting in hospitalization due to pulmonary embolism (PE), myocardial infarction (MI) and stroke were investigated during the follow-up period.ResultsWhile no major bleeding events occured during follow-up in the treatment groups, Ctrl showed a high but evenly distributed rate all-cause mortality. All-cause mortality (CVM) was attenuated by prophylactic DOAC (0.6%, P < 0.001) and dipyridamole (0.7%, P < 0.001). This effect was also evident for both therapies after propensity score analyses using weighted binary logistic regression [DOAC: B = −3.33 (0.60), P < 0.001 and dipyridamole: B = −3.04 (0.76), P < 0.001]. While both treatment groups displayed a reduced rate of CVM [DOAC: B = −2.69 (0.74), P < 0.001 and dipyridamole: B = −17.95 (0.37), P < 0.001], the effect in the DOAC group was driven by reduction of both PE [B−3.12 (1.42), P = 0.012] and stroke [B = −3.08 (1.23), P = 0.028]. Dipyridamole significantly reduced rates of PE alone [B = −17.05 (1.01), P < 0.001].ConclusionLate cardiovascular events and all-cause mortality were high in the year following hospitalization for COVID-19. Application of prophylactic DOAC or dipyridamole in the early post-discharge period improved mid- and long-term CVO and all-cause mortality in COVID-19 survivors.https://www.frontiersin.org/articles/10.3389/fcvm.2022.916156/fullCOVID-19long COVID-19direct anticoagulationdipyridamolecardiovascular disease in COVID-19 |
| spellingShingle | Lukas J. Motloch Peter Jirak Moritz Mirna Lukas Fiedler Lukas Fiedler Paruir A. Davtyan Irina A. Lakman Irina A. Lakman Diana F. Gareeva Anton V. Tyurin Ruslan M. Gumerov Simon T. Matskeplishvili Valentin N. Pavlov Benzhi Cai Kristen Kopp Albert Topf Uta C. Hoppe Rudin Pistulli Naufal S. Zagidullin Early antithrombotic post-discharge therapy using prophylactic DOAC or dipyridamole improves long-term survival and cardiovascular outcomes in hospitalized COVID-19 survivors Frontiers in Cardiovascular Medicine COVID-19 long COVID-19 direct anticoagulation dipyridamole cardiovascular disease in COVID-19 |
| title | Early antithrombotic post-discharge therapy using prophylactic DOAC or dipyridamole improves long-term survival and cardiovascular outcomes in hospitalized COVID-19 survivors |
| title_full | Early antithrombotic post-discharge therapy using prophylactic DOAC or dipyridamole improves long-term survival and cardiovascular outcomes in hospitalized COVID-19 survivors |
| title_fullStr | Early antithrombotic post-discharge therapy using prophylactic DOAC or dipyridamole improves long-term survival and cardiovascular outcomes in hospitalized COVID-19 survivors |
| title_full_unstemmed | Early antithrombotic post-discharge therapy using prophylactic DOAC or dipyridamole improves long-term survival and cardiovascular outcomes in hospitalized COVID-19 survivors |
| title_short | Early antithrombotic post-discharge therapy using prophylactic DOAC or dipyridamole improves long-term survival and cardiovascular outcomes in hospitalized COVID-19 survivors |
| title_sort | early antithrombotic post discharge therapy using prophylactic doac or dipyridamole improves long term survival and cardiovascular outcomes in hospitalized covid 19 survivors |
| topic | COVID-19 long COVID-19 direct anticoagulation dipyridamole cardiovascular disease in COVID-19 |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.916156/full |
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