Evaluation of antithrombotic use and COVID-19 outcomes in a nationwide atrial fibrillation cohort
20 May 2022 | Author: Carl Marincowitz, Clinical Lecturer in Emergency Medicine
Our Open Access Publication of the Month, May: Selected by the Impact Committee for its research excellence
In this month’s review of published papers and pre-prints, the Early Career Committee considered dozens of articles made open access. They were ranked against core pillars of the HDR UK ethos: research quality, team science, scale, open science, patient and public involvement, impact and equality, diversity and inclusion. This month the committee has chosen “Evaluation of antithrombotic use and COVID-19 outcomes in a nationwide atrial fibrillation cohort”, by Handy et. al., as the winning publication.
Atrial fibrillation (AF) is a common disturbance of heart rhythm which can cause blood clots and lead to stroke. Use of antithrombotic drugs (mainly anticoagulants) is recommended to reduce the risk of stroke in AF patients. However, they are under-prescribed in the UK. There is also evidence from some small studies that anticoagulant use may reduce the risk of death in patients with atrial fibrillation hospitalised with COVID-19. Handy et. al. used linked electronic health records to identify 972,971 individuals with AF in England and identified factors associated with antithrombotics not being prescribed, despite the potential to reduce the risk of stroke. They also assessed whether antithrombotic use was associated with reduced risk of hospitalisation and death if patients were diagnosed with COVID-19.
The authors found 12.3% of patients were not prescribed antithrombotic medications. Both non-steroidal anti-inflammatory use and liver disease were strongly associated with an antithrombotic not being prescribed, likely due to the increased risk of bleeding. Although not conclusive evidence of causality, patients taking an antithrombotic were less likely to die, although were not less likely to be hospitalised, if they were diagnosed with COVID-19.
The committee scored the paper high on team science and scale as it brings together several researchers from across the four nations and uses data derived from a cohort all individuals registered with a GP in England. The project also included some patient and public involvement in reviewing and approving the project. The project provides important information regarding both antithrombotic use in patients with atrial fibrillation high risk for stroke and the potential for these medications to reduce mortality in these patients if they develop COVID-19.
HDR UK’s Early Career Committee would like to congratulate and commend the team for their contribution to HDR UK’s vision of uniting the UK’s health data to enable discoveries that improve people’s lives.
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