open access

Vol 28, No 5 (2021)
Review Article
Published online: 2021-08-09
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Pharmacotherapy of atrial fibrillation in COVID-19 patients

Anna Tomaszuk-Kazberuk12, Marek Koziński13, Justyna Domienik-Karłowicz14, Miłosz Jaguszewski15, Szymon Darocha16, Maciej Wybraniec17, Piotr Dobrowolski18, Karolina Kupczyńska19, Błażej Michalski19, Wojciech Wańha110, Agnieszka Kapłon-Cieślicka111
DOI: 10.5603/CJ.a2021.0088
·
Pubmed: 34382204
·
Cardiol J 2021;28(5):758-766.
Affiliations
  1. “Club 30”, Polish Cardiac Society, Poland
  2. Department of Cardiology, Medical University of Bialystok, Poland
  3. Department of Cardiology and Internal Medicine, Medical University of Gdansk, Gdynia, Poland
  4. Department of Internal Medicine and Cardiology with the Center for Diagnosis and Treatment of Thromboembolism, Medical University of Warsaw, Poland
  5. 1st Department of Cardiology, Medical University of Gdansk, Poland
  6. Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
  7. 1st Chair and Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
  8. Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
  9. Chair and Department of Cardiology, Medical University of Lodz, Poland
  10. Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
  11. 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland

open access

Vol 28, No 5 (2021)
Review articles — COVID-19
Published online: 2021-08-09

Abstract

The coronavirus pandemic disease 2019 (COVID-19) has changed the face of contemporary medicine. However, each and every medical practitioner must be aware of potential early and late complications of COVID-19, its impact on chronic diseases — especially ones as common as atrial fibrillation (AF) — and the possible interactions between patients’ chronic medications and pharmacotherapy of COVID-19. Patients with AF due to comorbidities and, often, elderly age are assumed to be at a higher risk of a severe course of COVID-19. This expert consensus summarizes the current knowledge regarding the pharmacotherapy of AF patients in the setting of the COVID-19 pandemic. In general, anticoagulation principles in quarantined or asymptomatic individuals remain unchanged. Nevertheless, it is advisable to switch from vitamin K antagonists to non-vitamin K antagonist oral anticoagulants (NOACs) whenever possible due to their consistent benefits and safety with fixed dosing and no monitoring. Additionally, in AF patients hospitalized due to mild or moderate COVID-19 pneumonia, we recommend continuing NOAC treatment or to switching to low-molecular-weight heparin (LMWH). On the other hand, in severely ill patients hospitalized in intensive care units, intravenous or subcutaneous dosing is preferable to oral, which is why the treatment of choice is either LMWH or unfractionated heparin. Finally, particularly in critical scenarios, the treatment strategy in COVID-19 patients with AF should be individualized based on possible interactions between anticoagulants, antiarrhythmics, antivirals, and antibiotics. In this consensus, we also discuss how to safely perform COVID-19 vaccination in anticoagulated AF patients.

Abstract

The coronavirus pandemic disease 2019 (COVID-19) has changed the face of contemporary medicine. However, each and every medical practitioner must be aware of potential early and late complications of COVID-19, its impact on chronic diseases — especially ones as common as atrial fibrillation (AF) — and the possible interactions between patients’ chronic medications and pharmacotherapy of COVID-19. Patients with AF due to comorbidities and, often, elderly age are assumed to be at a higher risk of a severe course of COVID-19. This expert consensus summarizes the current knowledge regarding the pharmacotherapy of AF patients in the setting of the COVID-19 pandemic. In general, anticoagulation principles in quarantined or asymptomatic individuals remain unchanged. Nevertheless, it is advisable to switch from vitamin K antagonists to non-vitamin K antagonist oral anticoagulants (NOACs) whenever possible due to their consistent benefits and safety with fixed dosing and no monitoring. Additionally, in AF patients hospitalized due to mild or moderate COVID-19 pneumonia, we recommend continuing NOAC treatment or to switching to low-molecular-weight heparin (LMWH). On the other hand, in severely ill patients hospitalized in intensive care units, intravenous or subcutaneous dosing is preferable to oral, which is why the treatment of choice is either LMWH or unfractionated heparin. Finally, particularly in critical scenarios, the treatment strategy in COVID-19 patients with AF should be individualized based on possible interactions between anticoagulants, antiarrhythmics, antivirals, and antibiotics. In this consensus, we also discuss how to safely perform COVID-19 vaccination in anticoagulated AF patients.

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Keywords

atrial fibrillation, coronavirus, infection, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), coronavirus disease 2019 (COVID-19), non-vitamin K antagonist oral anticoagulants (NOACs), direct oral anticoagulants (DOACs)

About this article
Title

Pharmacotherapy of atrial fibrillation in COVID-19 patients

Journal

Cardiology Journal

Issue

Vol 28, No 5 (2021)

Article type

Review Article

Pages

758-766

Published online

2021-08-09

DOI

10.5603/CJ.a2021.0088

Pubmed

34382204

Bibliographic record

Cardiol J 2021;28(5):758-766.

Keywords

atrial fibrillation
coronavirus
infection
severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)
coronavirus disease 2019 (COVID-19)
non-vitamin K antagonist oral anticoagulants (NOACs)
direct oral anticoagulants (DOACs)

Authors

Anna Tomaszuk-Kazberuk
Marek Koziński
Justyna Domienik-Karłowicz
Miłosz Jaguszewski
Szymon Darocha
Maciej Wybraniec
Piotr Dobrowolski
Karolina Kupczyńska
Błażej Michalski
Wojciech Wańha
Agnieszka Kapłon-Cieślicka

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