José Miguel Rivera-Caravaca, Universidad de Murcia
Iván J. Núñez-Gil, Hospital Clínico San Carlos de Madrid
Gregory Y.H. Lip, University of Liverpool
Aitor Uribarri, Hospital Clínico Universitario de Valladolid
María C. Viana-Llamas, Hospital Universitario de Guadalajara
Adelina Gonzalez, Hospital Infanta Sofía
Alex F. Castro-Mejía, Hospital General del norte de Guayaquil IESS Los Ceibos
Berta Alonso González, Hospital Universitario La Paz
Emilio Alfonso, Instituto de Cardiologia y Cirugia Cardiovascular
Juan Fortunato García Prieto, Hospital de Manises
Chiara Cavallino, Ospedale S. Andrea
Bernardo Cortese, San Carlo Clinic
Gisela Feltes, Hospital Nuestra Señora de América
Inmaculada Fernández-Rozas, Hospital Severo Ochoa
Jaime Signes-Costa, Hospital Clinico Universitario de Valencia
Jia Huang, Shenzhen Second People's Hospital
Marcos García Aguado, Hospital Universitario Puerta de Hierro Majadahonda
Martino Pepe, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari
Rodolfo Romero, Hospital Universitario de Getafe
Enrico Cerrato, Azienda Ospedaliero-Universitaria San Luigi Gonzaga
Víctor Manuel Becerra-Muñoz, Hospital Universitari Virgen de la Victoria
Sergio Raposeiras Roubin, University Hospital Álvaro Cunqueiro
Francesco Santoro, Azienda Sanitaria Locale della Provincia di Barletta-Andria-Trani
Rodrigo Bagur, London Health Sciences Centre
Luciano Sposato, London Health Sciences CentreFollow
Ibrahim El-Battrawy, Universität Mannheim
Alvaro López Masjuan, Hospital Universitario Juan Ramón Jiménez
Antonio Fernandez-Ortiz, Hospital Clínico San Carlos de Madrid
Vicente Estrada, Hospital Clínico San Carlos de Madrid
Carlos Macaya, Hospital Clínico San Carlos de Madrid

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International Journal of Clinical Practice



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Background. Most evidence regarding anticoagulation and COVID-19 refers to the hospitalization setting, but the role of oral anticoagulation (OAC) before hospital admission has not been well explored. We compared clinical outcomes and short-term prognosis between patients with and without prior OAC therapy who were hospitalized for COVID-19. Methods. Analysis of the whole cohort of the HOPE COVID-19 Registry which included patients discharged (deceased or alive) after hospital admission for COVID-19 in 9 countries. All-cause mortality was the primary endpoint. Study outcomes were compared after adjusting variables using propensity score matching (PSM) analyses. Results. 7698 patients were suitable for the present analysis (675 (8.8%) on OAC at admission: 427 (5.6%) on VKAs and 248 (3.2%) on DOACs). After PSM, 1276 patients were analyzed (638 with OAC; 638 without OAC), without significant differences regarding the risk of thromboembolic events (OR 1.11, 95% CI 0.59-2.08). The risk of clinically relevant bleeding (OR 3.04, 95% CI 1.92-4.83), as well as the risk of mortality (HR 1.22, 95% CI 1.01-1.47; log-rank p value = 0.041), was significantly increased in previous OAC users. Amongst patients on prior OAC only, there were no differences in the risk of clinically relevant bleeding, thromboembolic events, or mortality when comparing previous VKA or DOAC users, after PSM. Conclusion. Hospitalized COVID-19 patients on prior OAC therapy had a higher risk of mortality and worse clinical outcomes compared to patients without prior OAC therapy, even after adjusting for comorbidities using a PSM. There were no differences in clinical outcomes in patients previously taking VKAs or DOACs. This trial is registered with NCT04334291/EUPAS34399.