Switching warfarin patients to a direct oral anticoagulant during the Coronavirus Disease-19 pandemic

Anticoagulation therapy in non-valvular atrial fibrillation in the COVID-19 era: is it time to reconsider our therapeutic strategy?

“… 4 , 5 Healthcare systems apply technologies of telemedicine and remote monitoring of patients with chronic diseases, such as AF to avoid frequent visits of patients to healthcare centres and/or hospitals. 6 For instance, Li et al . 7 conducted a study in China to evaluate the efficacy of remote anticoagulation management with a NOAC (rivaroxaban) by pharmacists for elderly patients with non-valvular AF during the COVID-19 pandemic.…”

“…According to a position statement of the Working Group on Cardiovascular Thrombosis of the Spanish Society of Cardiology 8 and the NHS ‘Clinical guide for the management of anticoagulant services during the coronavirus pandemic’, NOACs are recommended to minimize the need for anticoagulation monitoring in AF patients during the COVID-19 pandemic. 6 , 8 For hospitalized patients under treatment with a VKA who are eligible for prescription of a NOAC, it is recommended to change the VKA into NOAC during hospitalization in order to reduce visits to healthcare centres for subsequent monitoring after discharge, which may expose this high-risk population to SARS-CoV-2 infection. 8 The healthcare departments of some autonomous Spanish communities (e.g.…”

“…Andalusia, Community of Madrid, Region of Murcia) have already approved anticoagulation with NOACs for patients with a recently diagnosed AF to avoid the frequent INR monitoring required at the start of VKA. 8 In a small, prospective study by Patel et al ., 6 telephone switching of warfarin patients to a NOAC was proven safe with good patients’ compliance.…”

Warfarin anticoagulation in the Covid-19 pandemic: Telephone-based management at a regional hematology outpatient center in Joinville, Brazil

“…Even before the pandemic, this preference was already reported by some patients. A well-structured health economics analysis of costs attributed to warfarin purchasing, PT testing, transportation to and from medical appointments and laboratory facilities is in order in the continuation of this study to compare our population with published data [4][5][6][7][8][9][10]. This is especially necessary considering the clinical possibility for many patients (about 80% of our patient population) of switching from warfarin to direct oral anticoagulants (DOAC).…”

“…This is especially necessary considering the clinical possibility for many patients (about 80% of our patient population) of switching from warfarin to direct oral anticoagulants (DOAC). Recently, switching to DOAC due to COVID-19 restrictions has been reported with favorable outcomes [10] . In Brazil, warfarin is offered in the public health system and, should a patient decide to purchase it, its monthly out-of-pocket cost is approximately twenty times less expensive than a DOAC.…”