Edoxaban vs low molecular weight heparin in COVID-19 hospitalized patients with atrial fibrillation

Objective During the first wave of the SARS-CoV-2 pandemic, management of anticoagulation therapy in hospitalized patients with atrial fibrillation (AF) was simplified to low-molecular-weight heparin (LMWH), mainly due to the risk of drug-drug interactions. However, not all oral anticoagulants carry the same risk. Methods Observational, retrospective, and multicenter study that consecutively included hospitalized patients with non-valvular AF who received anticoagulant treatment with LMWH or edoxaban concomitantly with empirical therapy for COVID-19 infection. Results From March 5th to April 27th, 2020, 232 patients were included (80.3 ± 7.7 years, 50.0% men, CHA 2 DS 2 -VASc 4.1 ± 1.4; HAS-BLED 2.6 ± 1.0). Regarding COVID-19 therapy during hospitalization, patients were taking azithromycin (98.7%), hydroxychloroquine (89.7%), and ritonavir/lopinavir (81.5%). Peak D-dimer was significantly lower in the edoxaban group. The mean length of hospital stay was 14.6 ± 7.2 days and mean total follow-up (from admission to the last visit) was 31.6 ± 13.4 days. Furthermore, 12.9% of patients required admission to the intensive care unit, 18.5% of patients died, and 9.9% had a bleeding complication (34.8% major bleeding). Except for length of hospital stay, which was longer in patients taking LMWH (16.0 ± 7.7 vs 13.3 ± 6.5 days; P = 0.005), data for the remaining outcomes were similar in patients treated with edoxaban and those treated with LMWH. Conclusions Mortality rates, arterial and venous thromboembolic complications and bleedings did not significantly differ between patients with AF who received anticoagulation therapy with edoxaban or LMWH. However, the duration of hospitalization was significantly lower with edoxaban. Edoxaban had a similar therapeutic profile to LMWH and may provide additional benefit.