{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T11:45:17Z","timestamp":1782992717384,"version":"3.54.5"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,1,20]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Concomitant use of nirmatrelvir\/ritonavir with direct oral anticoagulants (DOACs) for COVID\u201019 is challenging due to potential drug\u2013drug interactions. This study assessed the safety and effectiveness of nirmatrelvir\/ritonavir compared with RNA\u2010dependent RNA polymerase inhibitors in patients with COVID\u201019 and atrial fibrillation treated with a DOAC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We conducted a territory\u2010wide retrospective study of patients with COVID\u201019 hospitalized in Hong Kong between January and November 2022 for antiviral therapy who had atrial fibrillation managed with a DOAC. Clinical outcomes including 30\u2010day all\u2010cause death, ischemic stroke, myocardial infarction, and bleeding events were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Overall, 1297 (91%) patients were prescribed an RNA\u2010dependent 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\u2010molecular\u2010weight heparin, and 20 (15.7%) withheld anticoagulation therapy. After propensity score matching (n=1270), 1143 and 127 patients were in the RNA\u2010dependent RNA polymerase inhibitor and nirmatrelvir\/ritonavir groups, respectively. On univariate analysis, the 30\u2010day all\u2010cause death was lower in the nirmatrelvir\/ritonavir group (5.51% versus 12.1%;\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.033). However, after adjusting for covariates including age and COVID\u201019 severity, this difference was no longer statistically significant. The incidence of bleeding events was not significantly different between groups (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.654), and there were no statistically significant differences in ischemic stroke, myocardial infarction, or need for ventilatory support.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">In a territory\u2010wide cohort of hospitalized patients with COVID\u201019 and atrial fibrillation on a DOAC, nirmatrelvir\/ritonavir therapy was associated with lower unadjusted 30\u2010day all\u2010cause death compared with RNA\u2010dependent RNA polymerase inhibitors; however, this difference was not significant after adjusting for age and COVID\u201019 severity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.124.039113","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T13:03:06Z","timestamp":1768827786000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Safety and Efficacy of Concomitant Nirmatrelvir\/Ritonavir and Direct Oral Anticoagulant Therapies for COVID\u201019 Among Patients With Atrial Fibrillation"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5205-9440","authenticated-orcid":false,"given":"Chun\u2010Ka","family":"Wong","sequence":"first","affiliation":[{"name":"The University of Hong Kong","place":["China"]},{"name":"The University of Hong Kong\u2010Shenzhen Hospital","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0375-5276","authenticated-orcid":false,"given":"Benjamin 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Chor\u2010Cheung","family":"Tam","sequence":"additional","affiliation":[{"name":"The University of Hong Kong","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7168-7976","authenticated-orcid":false,"given":"Minqing","family":"Lin","sequence":"additional","affiliation":[{"name":"The University of Hong Kong","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5611-1637","authenticated-orcid":false,"given":"Wang\u2010Chun","family":"Kwok","sequence":"additional","affiliation":[{"name":"The University of Hong Kong","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon Cheung\u2010Chi","family":"Lam","sequence":"additional","affiliation":[{"name":"The University of Hong Kong","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwong\u2010Yue 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