Key result
Rivaroxaban shows no short-term mortality benefit over control regimens in COVID-19.
Why the study?
The effectiveness and safety of rivaroxaban anticoagulation therapy in COVID-19 patients required evaluation through randomized controlled trials.
Does rivaroxaban anticoagulation reduce mortality, hospitalization, or thrombotic events in COVID-19 patients?
Meta-Analysis (n=3,323)
Does rivaroxaban anticoagulation reduce mortality, hospitalization, or thrombotic events in COVID-19 patients?
Absolute Event Rate: 2.96% vs 2.64%
In COVID-19 patients, rivaroxaban does not significantly reduce short-term mortality or hospitalization compared to control, and while it reduces thrombotic events compared to placebo, it is not superior to heparin/LMWH and may increase overall bleeding.
Rivaroxaban should not be used to reduce mortality in COVID-19; confirms no survival benefit while highlighting bleeding trade-off with thrombotic reduction.
OBJECTIVES: To evaluate the effectiveness and safety of rivaroxaban anticoagulation in COVID-19 patients. METHODS: PubMed, Embase, Cochrane Library electronic databases, and ClinicalTrials.gov were searched to identify all relevant randomized controlled trial studies from December 2019 to July 2023. RESULTS: A total of 6 randomized controlled trials, which included a total of 3323 patients, were considered for evaluation. Overall, short-term all-cause mortality and hospitalization rates were not significantly different between the rivaroxaban and control groups. Thrombotic events were significantly reduced in the rivaroxaban prophylaxis group compared to the placebo control group. However, the reduction in thrombotic events was not significantly different between rivaroxaban therapy and heparin or low-molecular-weight heparin (LMWH). Rivaroxaban prophylaxis and the therapeutic dose may be associated with a higher rate of overall bleeding rate, but major bleeding rates did not differ substantially. CONCLUSION: .
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Shen et al. (2024) conducted a meta-analysis in COVID-19 (n=3,323). Rivaroxaban vs. Placebo, enoxaparin, or unfractionated heparin was evaluated on Short-term all-cause mortality (within 35 days). Rivaroxaban did not significantly reduce short-term all-cause mortality compared to control regimens in patients with COVID-19, though prophylactic doses reduced thrombotic events at the cost of increased overall bleeding.
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