Key result
Dabigatran may be considered a first-line choice for oral anticoagulation at discharge in patients with non-valvular atrial fibrillation and COVID-19 due to its favorable safety profile, low hepatotoxicity risk, and lack of cytochrome P450 metabolism.
Why the study?
Selecting oral anticoagulants at discharge for AF patients recovering from COVID-19 requires addressing thrombotic risks, antiviral drug-drug interactions, and potential hepatotoxicity.
Does dabigatran reduce the risk of drug-drug interactions and hepatotoxicity compared to other oral anticoagulants in patients with non-valvular atrial fibrillation and COVID-19 infection?
Does dabigatran reduce the risk of drug-drug interactions and hepatotoxicity compared to other oral anticoagulants in patients with non-valvular atrial fibrillation and COVID-19 infection?
Dabigatran may be the preferred oral anticoagulant at discharge for patients with non-valvular atrial fibrillation and COVID-19 due to its lack of CYP450 metabolism, which minimizes drug-drug interactions and hepatotoxicity risk.
May support dabigatran consideration in NVAF with COVID-19; hypothesis-generating and should not yet change practice.
Atrial fibrillation is a frequent complication among patients with severe coronavirus disease-2019 (COVID-19) infection. Both direct and indirect mechanisms through COVID-19 have been described to explain this relationship. COVID-19 infection increases the risk of developing both arterial and venous thrombotic complications through systemic coagulation activation, leading to increased mortality. Chronic oral anticoagulation is essential to reduce the thromboembolic risk among AF patients. Switching to low-molecular-weight heparin has been recommended during hospitalization for COVID-19 infection. Of note, at discharge, the prescription of direct oral anticoagulants may offer some advantages over vitamin K antagonists. However, oral anticoagulants should only be prescribed after the consideration of drug-drug interactions with antiviral therapies as well as of the risk of hepatotoxicity, which is common among individuals with severe COVID-19 pneumonia. Not all anticoagulants have the same risk of hepatotoxicity; dabigatran has shown a good efficacy and safety profile and could have a lower risk of hepatotoxicity. Furthermore, its metabolism by cytochrome P450 is absent and it has a specific reversal agent. Therefore, dabigatran may be considered as a first-line choice for oral anticoagulation at discharge after COVID-19 infection. In this review, the available information on the antithrombotic management of AF patients at discharge after COVID-19 infection is updated. In addition, a practical algorithm, considering renal and liver function, which facilitates the anticoagulation choice at discharge is presented.
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Iturbe-Hernández et al. (2020) conducted a review in Non-valvular atrial fibrillation and COVID-19 infection. Dabigatran vs. Vitamin K antagonists or other direct oral anticoagulants was evaluated. Dabigatran may be considered a first-line choice for oral anticoagulation at discharge in patients with non-valvular atrial fibrillation and COVID-19 due to its favorable safety profile, low hepatotoxicity risk, and lack of cytochrome P450 metabolism.
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