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The role of oral anticoagulation during the COVID-19 pandemic has been debated widely. We studied the clinical outcomes of COVID-19 hospitalizations in patients who were on long-term anticoagulation. The Nationwide Inpatient Sample (NIS) database from 2020 was queried to identify COVID-19 patients with and without long-term anticoagulation. Multivariate regression analysis was used to calculate the adjusted odds ratio (aOR) of in-hospital outcomes. Of 1,060,925 primary COVID-19 hospitalizations, 102,560 (9.6%) were on long-term anticoagulation. On adjusted analysis, COVID-19 patients on anticoagulation had significantly lower odds of in-hospital mortality (aOR 0.61, 95% CI 0.58–0.64,  P  &lt; 0.001), acute myocardial infarction (aOR 0.72, 95% CI 0.63–0.83,  P  &lt; 0.001), stroke (aOR 0.79, 95% CI 0.66–0.95,  P  &lt; 0.013), ICU admissions, (aOR 0.53, 95% CI 0.49–0.57,  P  &lt; 0.001) and higher odds of acute pulmonary embolism (aOR 1.47, 95% CI 1.34–1.61,  P  &lt; 0.001), acute deep vein thrombosis (aOR 1.17, 95% CI 1.05–1.31,  P  = 0.005) compared to COVID-19 patients who were not on anticoagulation. Compared to COVID-19 patients not on long-term anticoagulation, we observed lower in-hospital mortality, stroke and acute myocardial infarction in COVID-19 patients on long-term anticoagulation. Prospective studies are needed for optimal anticoagulation strategies in hospitalized patients.

Contemporary outcomes of long-term anticoagulation in COVID-19 patients: a regression matched sensitivity analysis of the national inpatient sample