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Question clinique
Does post-discharge thromboprophylaxis benefit patients who are hospitalized with COVID-19 and are at high risk for venous thromboembolism?
L’Essentiel
For patients hospitalized with COVID-19 who are at high risk for VTE, extended thromboprophylaxis with rivaroxaban upon discharge reduced the number of thrombotic events without increasing the number of bleeding events. One would need to treat 16 patients with extended thromboprophylaxis to prevent one thrombotic event. 1b
Référence
Plan de l'etude: Randomized controlled trial (nonblinded)
Financement: Industry
Cadre: Inpatient (any location) with outpatient follow-up
Sommaire
In this industry-funded study from Brazil, the authors investigated the use of extended thromboprophylaxis in patients who were hospitalized with COVID-19 and were at increased risk for venous thromboembolism (VTE) based on a validated risk score (IMPROVE VTE) and D-dimer levels. Patients with an IMPROVE VTE score of at least 4 and patients with a score of 2 to 3 plus an increased D-dimer level were included. Patients with active cancer, gastrointestinal ulcers, chronic kidney disease, and recent bleeding and those using dual antiplatelet therapy were excluded. All patients received standard prophylactic doses of enoxaparin, unfractionated heparin, or fondaparinux while in the hospital. Upon discharge, those in the treatment group (n = 159) received rivaroxaban 10 mg daily for 35 days while those in the control group (n = 159) received no anticoagulation. The 2 groups were similar at baseline: mean age was 57 years, 40% were women, median hospital stay was 8 days, and approximately half in each group required a stay in the intensive care unit. Although the study protocol called for computed tomography angiogram and lower limb ultrasound to assess for VTE in all patients at day 35, the percentage of patients who were actually evaluated was higher in the treatment group. Despite this, more clots were found in the control group. For the composite outcome of symptomatic and asymptomatic VTE, symptomatic arterial thromboembolism, and cardiovascular death at day 35, the treatment group fared better (3.1% vs 9.4%; relative risk [RR] 0.33; 95% CI 0.13 - 0.90; P = .03). This was driven primarily by a lower rate of symptomatic and fatal VTE in the treatment group (0.6% vs 5.0%; RR 0.13; 0.02 - 0.99). There were no major bleeding events in either group.
Reviewer
Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL
Commentaires
doacs
thromboprophylaxis benefit
post discharge for covid
rx with xarelto reduces clots