Edoxaban Versus Low-Molecular-Weight Heparin in Hospitalized COVID-19 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) followed by oral anticoagulation, mainly owing to the risk of drug–drug interactions. However...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2023-06-01
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| Series: | Clinical and Applied Thrombosis/Hemostasis |
| Online Access: | https://doi.org/10.1177/10760296231180865 |
| _version_ | 1797788163107717120 |
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| author | Pável Olivera César Velásquez-Escandón Desirée Campoy Katia Flores Tania Canals Erik Johansson María José Herranz Laia Martínez Juan José Cerezo-Manchado Ramón Salinas |
| author_facet | Pável Olivera César Velásquez-Escandón Desirée Campoy Katia Flores Tania Canals Erik Johansson María José Herranz Laia Martínez Juan José Cerezo-Manchado Ramón Salinas |
| author_sort | Pável Olivera |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-13T01:31:42Z |
| format | Article |
| id | doaj.art-16c4c761edd147c9a860767c60163237 |
| institution | Directory Open Access Journal |
| issn | 1938-2723 |
| language | English |
| last_indexed | 2024-03-13T01:31:42Z |
| publishDate | 2023-06-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Clinical and Applied Thrombosis/Hemostasis |
| spelling | doaj.art-16c4c761edd147c9a860767c601632372023-07-04T07:03:25ZengSAGE PublishingClinical and Applied Thrombosis/Hemostasis1938-27232023-06-012910.1177/10760296231180865Edoxaban Versus Low-Molecular-Weight Heparin in Hospitalized COVID-19 Patients With Atrial FibrillationPável Olivera0César Velásquez-Escandón1Desirée Campoy2Katia Flores3Tania Canals4Erik Johansson5María José Herranz6Laia Martínez7Juan José Cerezo-Manchado8Ramón Salinas9 Thrombosis and Hemostasis Unit, Department of Hematology, Vall d'Hebron University Hospital, Barcelona, Spain Department of Hematology, Fundación Sanitària Mollet, Barcelona, Spain Thrombosis and Hemostasis Unit, Department of Hematology, Vall d'Hebron University Hospital, Barcelona, Spain Department of Hematology, General University Hospital of Catalonia, Barcelona, Spain Department of Hematology, University Hospital Sant Joan de Reus, Tarragona, Spain Department of Hematology, General University Hospital of Catalonia, Barcelona, Spain Department of Hematology, Hospital Sant Pau I Santa Tecla, Tarragona, Spain Department of Hematology, University Hospital Sant Joan de Reus, Tarragona, Spain Department of Hematology, University Hospital Clínico Santa Lucía, Cartagena, Spain Department of Hematology, University Hospital Sagrat Cor, Barcelona, SpainObjective 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.https://doi.org/10.1177/10760296231180865 |
| spellingShingle | Pável Olivera César Velásquez-Escandón Desirée Campoy Katia Flores Tania Canals Erik Johansson María José Herranz Laia Martínez Juan José Cerezo-Manchado Ramón Salinas Edoxaban Versus Low-Molecular-Weight Heparin in Hospitalized COVID-19 Patients With Atrial Fibrillation Clinical and Applied Thrombosis/Hemostasis |
| title | Edoxaban Versus Low-Molecular-Weight Heparin in Hospitalized COVID-19 Patients With Atrial Fibrillation |
| title_full | Edoxaban Versus Low-Molecular-Weight Heparin in Hospitalized COVID-19 Patients With Atrial Fibrillation |
| title_fullStr | Edoxaban Versus Low-Molecular-Weight Heparin in Hospitalized COVID-19 Patients With Atrial Fibrillation |
| title_full_unstemmed | Edoxaban Versus Low-Molecular-Weight Heparin in Hospitalized COVID-19 Patients With Atrial Fibrillation |
| title_short | Edoxaban Versus Low-Molecular-Weight Heparin in Hospitalized COVID-19 Patients With Atrial Fibrillation |
| title_sort | edoxaban versus low molecular weight heparin in hospitalized covid 19 patients with atrial fibrillation |
| url | https://doi.org/10.1177/10760296231180865 |
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