Direct oral anticoagulant use and risk of severe COVID-19

BACKGROUND

Hypercoagulability and thromboembolism are prominent features of severe COVID-19, and ongoing anticoagulant use might be protective.

METHODS

We conducted a nationwide register-based cohort study in Sweden, February through May, 2020, to assess whether ongoing direct oral anticoagulant (DOAC) use was associated with reduced risk of hospital admission for laboratory-confirmed COVID-19, or a composite of intensive care unit (ICU) admission or death due to laboratory-confirmed COVID-19.

RESULTS

DOAC use (n = 103 703) was not associated with reduced risk of hospital admission for COVID-19 (adjusted hazard ratio [aHR] [95% confidence interval] 1.00 [0.75-1.33] vs. nonuse atrial fibrillation comparator [n = 36 875]; and aHR 0.94 [0.80-1.10] vs. nonuse cardiovascular disease comparator [n = 355 699]), or ICU admission or death due to COVID-19 (aHRs 0.76 [0.51-1.12], and 0.90 [0.71-1.15], respectively).

CONCLUSION

Ongoing DOAC use was not associated with reduced risk of severe COVID-19, indicating that prognosis would not be modified by early outpatient DOAC initiation.

Effects of preparatory information of a myelogram on patients' expectations and anxiety levels

The major purposes of this quasi-experimental study were to describe the differences between pre-myelogram anxiety levels in patients who received pre-test information and those who received no preparatory information, to examine differences in post-teaching anxiety level between patients who received "sensory information" and those who received "procedural information," to measure the degree to which patients' expectations were congruent with their actual myelogram experience, and to determine the relationship between the teaching protocols and the incidence of post-myelogram side effects. Thirty patients were randomly assigned to one of three information conditions; sensory, procedural or no information. The intervention consisted of a 5-min tape recorded message of either procedural or sensory information. Patients who received procedural information reported less anxiety than patients who received no information or sensory information. Congruence between expected and actual sensations experienced was not found. Subjects exposed to sensory information reported significantly greater number of side effects than subjects in the control or procedural groups.