Does Chronic Treatment with Oral Anticoagulants Ameliorate the Clinical Course of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Coronavirus Disease 2019 (COVID-19)?

Abstract

The risk of ischemic stroke in patients with nonvalvular atrial fibrillation (NVAF) increases from 1.5% at 50 to 59 years of age to 23.5% at 80 to 89 years of age, 1 and this is reflected in the CHA 2 DS 2 -VASc score. 2 The incidence of venous thromboembolism (VTE) also increases from 0.1% by 1% per year at 50 years of age. 3 However, the incidence of NVAF was not higher in older patients hospitalized with coronavirus disease 2019 (COVID-19). Mortality rates in patients with COVID-19were associated with older age, 4 as well as diabetes and hypertension, which are also risk factors for adverse outcomes in NVAF. 5 Surprisingly, mortality of COVID-19 patients was not associated with a history of NVAF and VTE. The American Heart Association has established a registry "Get With The Guidelines (GWTG)" to collect data on COVID-19 patients hospitalized with NVAF, coronary artery disease, heart failure, stroke, and in-hospital cardiac arrest. Active viral or bacterial infections are being documented during hospitalization, including emerging infectious diseases such as COVID-19. atients with NVAF and VTE are preferentially treated with a fixed dose of direct oral anticoagulants (DOACs) or with vitamin K antagonists (VKA) adjusted according to the international normalized ratio (INR) to prevent ischemic stroke and recurrent VTE. herefore, given the preceding background, we propose that patients on long-term oral anticoagulant treatment may be protected from a more severe course of COVID-19 disease (Fig. 1) . Differences between VKA and DOACs and between factor Xa inhibitors (apixaban, edoxaban, and rivaroxaban) and the thrombin inhibitor dabigatran may affect the relative severity of COVID-19, although this needs

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