Key result
Post-discharge rivaroxaban daily holds the strongest evidence for thromboprophylaxis in high-risk COVID-19.
Why the study?
This review examines the rationale and evidence for prolonged use of anticoagulants after hospital discharge in patients with COVID-19 who do not have an additional indication for anticoagulation.
Answers are grounded in this paper and cite their sources.
Supports extended post-discharge anticoagulation in selected COVID-19 patients; extends pre-pandemic medical prophylaxis RCT data to a novel setting.
This review discusses reasons for prolonged use of anticoagulants after discharge of patients with COVID-19 without additional indication for anticoagulation. Data regarding rate of thrombotic and thromboembolic complications in patients with COVID-19 after discharge from the hospital are presented. Large randomized controlled trials EXCLAIM, ADOPT, MAGELLAN, APEX and MARINER with prolonged use of anticoagulants in patients hospitalized with acute nonsurgical diseases before pandemia of COVID-19 are discussed. The first prospective randomized controlled trial MICHELLE with direct oral anticoagulant rivaroxaban in a dose 10 mg once daily after discharge of patients with COVID-19 with high risk at least venous thromboembolism are analyzed. It seems that the most relevant approach for the determination of indications for prolonged use of anticoagulants in doses dedicated for primary prevention of venous thromboembolism after discharge of patients with COVID-19 without apparent indication for anticoagulation is a modified IMPROVE VTE risk score with the addition of elevated in-hospital D-dimer level. And the most well-studied approach for anticoagulation in these patients is a direct peroral anticoagulant rivaroxaban 10 mg once daily for 35 (and possibly up to 45) days after discharge.
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I. S. Yavelov (2022) conducted a review in COVID-19. Rivaroxaban was evaluated on Thrombotic and thromboembolic complications / venous thromboembolism. Rivaroxaban daily for 35-45 days is the most well-studied post-discharge VTE prophylaxis for COVID-19 patients selected via modified IMPROVE score and D-dimer.
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