The Efficacy and Safety of Prolonged Oral Anticoagulation for the Prevention of Thromboembolic Events in Patients Recovered From COVID-19 1 Year After Hospital Discharge: The SARCOV-19 Prospective Registry

Abstract

Our objective in this study is to know the predictors of thromboembolic events 1 year after hospitalization for severe COVID-19 and the benefit of preventive oral anticoagulation for 1 month to placebo after release. We conducted a prospective study to determine the benefit of preventive anticoagulation upon discharge from the hospital and to determine the predictive factors of thromboembolic events. We included 720 patients in the SARCOV-19 Registry, with a mean age of 62.07 (±18.11), and 61.1% male. After 1 year, 60 thromboembolic events were observed, 45 in patients on a placebo, and 15 in patients on a direct oral anticoagulant. The predictive factors determined for these events were the presence of cardiac disease, elevation of D-dimer during hospitalization, myocardial damage defined by elevation of troponins more than 6 times normal, and the use of mechanical ventilation. However, the use of preventive anticoagulation protects against thrombotic events and reduces the risk of a thromboembolic event at 1 year with a relative risk of 0.49 compared to a placebo. The prolongation of the preventive anticoagulation at the exit will protect with a decrease of almost 50% of the risk against thrombotic events and this without increasing the risk of bleeding.

Prophylactic rivaroxaban in the early post-discharge period reduces the rates of hospitalization for atrial fibrillation and incidence of sudden cardiac death during long-term follow-up in hospitalized COVID-19 survivors

“…This speculation is supported by a recent report from the SARCOV-19 registry evaluating 30 days of anticoagulation in COVID-19 patients upon hospital discharge. Of note, consistent with our data, the authors were able to demonstrate a reduction of thromboembolic events during a FU of 1 year ( Aidouni et al, 2023 ). While the described results seem only hypothesis-generating, the large ongoing double-blind, placebo-controlled randomized control ACTIV-4c trial (NCT04650087) is currently evaluating midterm cardiovascular outcomes (90 days) after a 30 days regime of prophylactic apixaban started upon hospital discharge ( Ortel, 2023 ).…”

Appropriate thromboprophylaxis strategy for COVID-19 patients on dosage, antiplatelet therapy, outpatient, and postdischarge prophylaxis: a meta-analysis of randomized controlled trials

“…In studies 19 , 39 , 41 investigating the postdischarge prophylaxis for postdischarge patients, postdischarge prophylaxis demonstrated a statistically significant lower risk of venous thromboembolism compared to no prophylaxis (RR, 0.49; 95% CI: 0.31–0.76) (Fig. 7 A).…”

“…Moreover, three studies investigated the use of additional antiplatelet therapy, primarily P2Y12 agonists, with one study also including aspirin in the treatment. Furthermore, three studies 19 , 39 , 41 explored postdischarge prophylaxis and four studies 15 , 16 , 18 , 40 explored prophylactic anticoagulation for outpatients, with one study 18 using LMWH (Table 1 ).…”

“…Nineteen studies had some concerns of bias, mainly because all these studies were open-label. Two studies 32 , 39 had some concerns about the selection of the reported results because they did not report major bleeding or mortality. Only six studies 11 , 16 , 19 , 29 , 30 , 40 were assessed as low risk across all domains.…”

Risk of pulmonary embolism and deep vein thrombosis following COVID‐19: a nationwide cohort study

“…22 A recent study of preventive anticoagulation upon hospital discharge found that prolonged preventive anticoagulation lowered the risk of thrombotic events without a corresponding increase in the risk of bleeding. 23 However, conflicting results regarding the risk of thromboembolism are being reported, and the consensus regarding which participants to be involved in preventive anticoagulation is scant. Stevens et al 24 demonstrated that the risk of COVID-19related thromboembolism is lower among ambulatory patients, but the risk was not lower among hospitalized patients who had COVID-19 vaccination.…”