Journal of the American Heart Association · 2026
Safety and Efficacy of Concomitant Nirmatrelvir/Ritonavir and Direct Oral Anticoagulant Therapies for COVID-19 Among Patients With Atrial Fibrillation.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Wong Chun-Ka, So Benjamin Yu-Fai, Leung Isaac Sze-Him, Choo Ali, Chiu Ho-On Alston Conrad, Tam Frankie Chor-Cheung, Lin Minqing, Kwok Wang-Chun, Lam Simon Cheung-Chi, Chan Kwong-Yue Eric, Un Ka-Chun, Lam Tsun-Ho, Chu Wing-Ming, Tam Anthony R, Hung Fan-Ngai, Lip Gregory Y H, Tse Hung-Fat
Аннотация
BACKGROUND: Concomitant use of nirmatrelvir/ritonavir with direct oral anticoagulants (DOACs) for COVID-19 is challenging due to potential drug-drug interactions. This study assessed the safety and effectiveness of nirmatrelvir/ritonavir compared with RNA-dependent RNA polymerase inhibitors in patients with COVID-19 and atrial fibrillation treated with a DOAC.
METHODS: We conducted a territory-wide retrospective study of patients with COVID-19 hospitalized in Hong Kong between January and November 2022 for antiviral therapy who had atrial fibrillation managed with a DOAC. Clinical outcomes including 30-day all-cause death, ischemic stroke, myocardial infarction, and bleeding events were evaluated.
RESULTS: Overall, 1297 (91%) patients were prescribed an RNA-dependent RNA polymerase inhibitor, and 127 (9%), nirmatrelvir/ritonavir. Among patients treated with nirmatrelvir/ritonavir, 77 (60.6%) continued DOAC treatment, 30 (23.6%) switched to low-molecular-weight heparin, and 20 (15.7%) withheld anticoagulation therapy. After propensity score matching (n=1270), 1143 and 127 patients were in the RNA-dependent RNA polymerase inhibitor and nirmatrelvir/ritonavir groups, respectively. On univariate analysis, the 30-day all-cause death was lower in the nirmatrelvir/ritonavir group (5.51% versus 12.1%; P=0.033). However, after adjusting for covariates including age and COVID-19 severity, this difference was no longer statistically significant. The incidence of bleeding events was not significantly different between groups (P=0.654), and there were no statistically significant differences in ischemic stroke, myocardial infarction, or need for ventilatory support.
CONCLUSIONS: In a territory-wide cohort of hospitalized patients with COVID-19 and atrial fibrillation on a DOAC, nirmatrelvir/ritonavir therapy was associated with lower unadjusted 30-day all-cause death compared with RNA-dependent RNA polymerase inhibitors; however, this difference was not significant after adjusting for age and COVID-19 severity.
METHODS: We conducted a territory-wide retrospective study of patients with COVID-19 hospitalized in Hong Kong between January and November 2022 for antiviral therapy who had atrial fibrillation managed with a DOAC. Clinical outcomes including 30-day all-cause death, ischemic stroke, myocardial infarction, and bleeding events were evaluated.
RESULTS: Overall, 1297 (91%) patients were prescribed an RNA-dependent RNA polymerase inhibitor, and 127 (9%), nirmatrelvir/ritonavir. Among patients treated with nirmatrelvir/ritonavir, 77 (60.6%) continued DOAC treatment, 30 (23.6%) switched to low-molecular-weight heparin, and 20 (15.7%) withheld anticoagulation therapy. After propensity score matching (n=1270), 1143 and 127 patients were in the RNA-dependent RNA polymerase inhibitor and nirmatrelvir/ritonavir groups, respectively. On univariate analysis, the 30-day all-cause death was lower in the nirmatrelvir/ritonavir group (5.51% versus 12.1%; P=0.033). However, after adjusting for covariates including age and COVID-19 severity, this difference was no longer statistically significant. The incidence of bleeding events was not significantly different between groups (P=0.654), and there were no statistically significant differences in ischemic stroke, myocardial infarction, or need for ventilatory support.
CONCLUSIONS: In a territory-wide cohort of hospitalized patients with COVID-19 and atrial fibrillation on a DOAC, nirmatrelvir/ritonavir therapy was associated with lower unadjusted 30-day all-cause death compared with RNA-dependent RNA polymerase inhibitors; however, this difference was not significant after adjusting for age and COVID-19 severity.