OBJECTIVES: The aim of this study is to evaluate the impact of the COVID-19 pandemic in patients with NVAF receiving anticoagulant treatment with vitamin K antagonists (VKA) or new direct-acting oral anticoagulants (NOAC) in clinical practice in Spain.

METHODS: This is an observational and retrospective study based on the electronic medical records of the BIG-PAC® database, which gathers information from 1.8 million individuals in Spain. Prevalent patients were those on treatment with NOAC/VKA on 14/03/2019 (pre-COVID-19 period, PCP) and on 14/03/2020 (COVID-19 period, CP), and were followed up to 12 months. Incident patients were those who started their treatment with NOAC/VKA between 15/03/2019 and 13/03/2020 (PCP) and from 15/03/2020 to 13/03/2021 (CP) and were analyzed only on their first day of treatment. Demographic characteristics, comorbidities, effectiveness, treatment patterns and healthcare resources utilization were compared in the groups of the study.

RESULTS: Prevalent patients amounted to 12,336 patients and 13,342 patients in the PCP and CP, respectively. Regarding incident patients, 1,612 patients and 1,602 patients were included in the PCP and in the CP, respectively. Prevalent patients on treatment with VKA had more cardiovascular events (strokes, episodes of thromboembolism and major bleedings) than those receiving NOAC (PCP: 7.9% vs. 4.2%, p<0.001; CP: 8.3% vs. 3.8%, p<0.001). VKA patients had a 12% higher mortality rate than those on treatment with NOAC (Hazard ratio=0.88 [95% CI: 0.81 – 0.95], p=0.033). In addition, NOAC patients had higher persistence rates after 12 months than VKA patients (PCP: 78.9% vs. 52.1%, p<0.001; CP: 80.3% vs. 49.2%, p<0.001), and overall, required fewer healthcare visits and hospitalizations during the pandemic than those on treatment with VKA.

CONCLUSIONS: In comparison to VKA, the use of NOAC in patients with NVAF seems to have reduced the incidence of cardiovascular events and the use of healthcare resources, particularly during the pandemic.