Edoxaban Versus Low-Molecular-Weight Heparin in Hospitalized COVID-19 Patients With Atrial Fibrillation.

Autor: Olivera P; Thrombosis and Hemostasis Unit, Department of Hematology, Vall d'Hebron University Hospital, Barcelona, Spain., Velásquez-Escandón C; Department of Hematology, Fundación Sanitària Mollet, Barcelona, Spain., Campoy D; Thrombosis and Hemostasis Unit, Department of Hematology, Vall d'Hebron University Hospital, Barcelona, Spain., Flores K; Department of Hematology, General University Hospital of Catalonia, Barcelona, Spain., Canals T; Department of Hematology, University Hospital Sant Joan de Reus, Tarragona, Spain., Johansson E; Department of Hematology, General University Hospital of Catalonia, Barcelona, Spain., Herranz MJ; Department of Hematology, Hospital Sant Pau I Santa Tecla, Tarragona, Spain., Martínez L; Department of Hematology, University Hospital Sant Joan de Reus, Tarragona, Spain., Cerezo-Manchado JJ; Department of Hematology, University Hospital Clínico Santa Lucía, Cartagena, Spain., Salinas R; Department of Hematology, University Hospital Sagrat Cor, Barcelona, Spain.
Jazyk: angličtina
Zdroj: Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis [Clin Appl Thromb Hemost] 2023 Jan-Dec; Vol. 29, pp. 10760296231180865.
DOI: 10.1177/10760296231180865
Abstrakt: 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) followed by oral anticoagulation, mainly owing 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 AF anticoagulated with LMWH followed by oral anticoagulation or edoxaban concomitantly with empirical COVID-19 therapy. Time-to-event (mortality, total bleeds, and admissions to ICU) curves, using an unadjusted Kaplan-Meier method and Cox regression model adjusted for potential confounders were constructed.
Results: A total of 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). During hospitalization, patients were taking azithromycin (98.7%), hydroxychloroquine (89.7%), and ritonavir/lopinavir (81.5%). The mean length of hospital stay was 14.6 ± 7.2 days, and total follow-up was 31.6 ± 13.4 days; 12.9% of patients required admission to ICU, 18.5% died, and 9.9% had a bleeding complication (34.8% major bleeding). Length of hospital stay was longer in patients taking LMWH (16.0 ± 7.7 vs 13.3 ± 6.5 days; P  = .005), but mortality and total bleeds were similar in patients treated with edoxaban and those treated with LMWH followed by oral anticoagulation.
Conclusions: Mortality rates, arterial and venous thromboembolic complications, and bleeds did not significantly differ between AF patients receiving anticoagulation therapy with edoxaban or LMWH followed by oral anticoagulation. However, the duration of hospitalization was significantly lower with edoxaban. Edoxaban had a similar therapeutic profile to LMWH followed by oral anticoagulation and may provide additional benefits.
Databáze: MEDLINE
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