• Medicina clinica · Jun 2022

    Prevalence of bleeding secondary to anticoagulation and mortality in patients with atrial fibrillation admitted with SARS-CoV-2 infection.

    • Ricardo Rubini-Costa, Francisco Bermúdez-Jiménez, Ricardo Rivera-López, Elena Sola-García, Hadi Nagib-Raya, Eduardo Moreno-Escobar, Miguel Ángel López-Zúñiga, Adela Briones-Través, Francisco Sanz-Herrera, Jose Miguel Sequí-Sabater, Juan Luis Romero-Cabrera, Javier Maíllo-Seco, Felipe Fernández-Vázquez, María Rivadeneira-Ruiz, Lucas López-Valero, Carlos Gómez-Navarro, Jose Antonio Aparicio-Gómez, Miguel Álvarez López, Luis Tercedor, María Molina-Jiménez, Rosa Macías-Ruiz, and Juan Jiménez-Jáimez.
    • Servicio de Cardiología, Hospital General Universitario Virgen de las Nieves, Avda. de las Fuerzas Armadas 2, 18014 Granada, Spain; Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain.
    • Med Clin (Barc). 2022 Jun 24; 158 (12): 569575569-575.

    Introduction And PurposeAtrial 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.MethodsWe 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.Results305 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.ConclusionsAF 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.Copyright © 2021 Elsevier España, S.L.U. All rights reserved.

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