Stability of vitamin K antagonist anticoagulation after COVID‐19 diagnosis

Abstract 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 p...

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Autores principales:	Eleonora Camilleri, Nienke van Rein, Felix J. M. van der Meer, Melchior C. Nierman, Willem M. Lijfering, Suzanne C. Cannegieter, The Dutch COVID & Thrombosis Coalition
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	anticoagulants coronavirus coumarins COVID‐19 international normalized ratio prothrombin time Diseases of the blood and blood-forming organs RC633-647.5
Acceso en línea:	https://doaj.org/article/3c754c07dfc24c7da8229b72505e669e
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spelling	oai:doaj.org-article:3c754c07dfc24c7da8229b72505e669e2021-11-29T09:35:28ZStability of vitamin K antagonist anticoagulation after COVID‐19 diagnosis2475-037910.1002/rth2.12597https://doaj.org/article/3c754c07dfc24c7da8229b72505e669e2021-10-01T00:00:00Zhttps://doi.org/10.1002/rth2.12597https://doaj.org/toc/2475-0379Abstract 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.Eleonora CamilleriNienke van ReinFelix J. M. van der MeerMelchior C. NiermanWillem M. LijferingSuzanne C. CannegieterThe Dutch COVID & Thrombosis CoalitionWileyarticleanticoagulantscoronaviruscoumarinsCOVID‐19international normalized ratioprothrombin timeDiseases of the blood and blood-forming organsRC633-647.5ENResearch and Practice in Thrombosis and Haemostasis, Vol 5, Iss 7, Pp n/a-n/a (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	anticoagulants coronavirus coumarins COVID‐19 international normalized ratio prothrombin time Diseases of the blood and blood-forming organs RC633-647.5
spellingShingle	anticoagulants coronavirus coumarins COVID‐19 international normalized ratio prothrombin time Diseases of the blood and blood-forming organs RC633-647.5 Eleonora Camilleri Nienke van Rein Felix J. M. van der Meer Melchior C. Nierman Willem M. Lijfering Suzanne C. Cannegieter The Dutch COVID & Thrombosis Coalition Stability of vitamin K antagonist anticoagulation after COVID‐19 diagnosis
description	Abstract 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	article
author	Eleonora Camilleri Nienke van Rein Felix J. M. van der Meer Melchior C. Nierman Willem M. Lijfering Suzanne C. Cannegieter The Dutch COVID & Thrombosis Coalition
author_facet	Eleonora Camilleri Nienke van Rein Felix J. M. van der Meer Melchior C. Nierman Willem M. Lijfering Suzanne C. Cannegieter The Dutch COVID & Thrombosis Coalition
author_sort	Eleonora Camilleri
title	Stability of vitamin K antagonist anticoagulation after COVID‐19 diagnosis
title_short	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_sort	stability of vitamin k antagonist anticoagulation after covid‐19 diagnosis
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/3c754c07dfc24c7da8229b72505e669e
work_keys_str_mv	AT eleonoracamilleri stabilityofvitaminkantagonistanticoagulationaftercovid19diagnosis AT nienkevanrein stabilityofvitaminkantagonistanticoagulationaftercovid19diagnosis AT felixjmvandermeer stabilityofvitaminkantagonistanticoagulationaftercovid19diagnosis AT melchiorcnierman stabilityofvitaminkantagonistanticoagulationaftercovid19diagnosis AT willemmlijfering stabilityofvitaminkantagonistanticoagulationaftercovid19diagnosis AT suzanneccannegieter stabilityofvitaminkantagonistanticoagulationaftercovid19diagnosis AT thedutchcovidthrombosiscoalition stabilityofvitaminkantagonistanticoagulationaftercovid19diagnosis
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Stability of vitamin K antagonist anticoagulation after COVID‐19 diagnosis

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