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Pharmacotherapy of atrial fibrillation in COVID-19 patients
Affiliations- “Club 30”, Polish Cardiac Society, Poland
- Department of Cardiology, Medical University of Bialystok, Poland
- Department of Cardiology and Internal Medicine, Medical University of Gdansk, Gdynia, Poland
- Department of Internal Medicine and Cardiology with the Center for Diagnosis and Treatment of Thromboembolism, Medical University of Warsaw, Poland
- 1st Department of Cardiology, Medical University of Gdansk, Poland
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
- 1st Chair and Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
- Chair and Department of Cardiology, Medical University of Lodz, Poland
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
open access
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.
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 articleTitle
Pharmacotherapy of atrial fibrillation in COVID-19 patients
Journal
Issue
Article type
Review Article
Pages
758-766
Published online
2021-08-09
Page views
13368
Article views/downloads
1341
DOI
Pubmed
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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