Efficacy and Safety of Oral Anticoagulants in the Treatment of COVID-19
https://doi.org/10.15360/1813-9779-2021-3-42-49
Abstract
Coagulopathy and associated thrombotic complications are common conditions seen in COVID-19. Therefore, anticoagulants are an integral part of the treatment of patients with COVID-19.
The aim of the study was to compare the efficacy of oral anticoagulants and low molecular weight heparins in the prevention of pulmonary embolism and their safety in terms of major bleeding incidence, as well as to evaluate the cost-effectiveness of using oral anticoagulants in the treatment of COVID-19.
Materials and methods. Two stages of patient management were compared: before and after the start of a widespread use of oral anticoagulants (OAC). The incidence of pulmonary embolism and gastrointestinal bleeding during the compared time periods was analyzed to assess the efficacy and safety of anticoagulants. To assess the cost-effectiveness, we compared the cost of anticoagulants per day of treatment and per patient.
Results. The incidence of pulmonary embolism and gastrointestinal bleeding did not differ during the compared time periods. Despite the increased frequency of anticoagulant use, the costs per day of treatment and per patient decreased after the start of a widespread use of OACs.
Conclusion. According to the results of the study, inclusion of OACs in COVID-19 management protocols allows to reduce treatment costs without compromising its efficacy and safety. However, the short period of comparison does not allow drawing any firm conclusions. Additional large-scale comparative studies are needed.
About the Authors
O. G. Ni
City Clinical Hospital № 40
Russian Federation
Russian Federation
Oksana G. Ni
7 Kasatkina Str., 129301 Moscow
D. V. Troshchansky
City Clinical Hospital № 40
Russian Federation
Russian Federation
Dmitry V. Troshchansky
7 Kasatkina Str., 129301 Moscow
D. N. Protsenko
City Clinical Hospital № 40; N.I. Pirogov Medical Research University
Russian Federation
Russian Federation
Denis N. Protsenko 12,
7 Kasatkina Str., 129301 Moscow; 1 Ostrovityanova Str., 117997 Moscow
I. N. Tyurin
City Clinical Hospital № 40
Russian Federation
Russian Federation
Igor N. Tyurin
E. A. Balanyuk
City Clinical Hospital № 40
Russian Federation
Russian Federation
Eleanor A. Balanyuk
7 Kasatkina Str., 129301 Moscow
References
1. TangN., Li D., WangX., Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020; 18 (4): 844-847. DOI: 10.1111/jth.14768
2. Middeldorp S., Coppens M., van Haaps T.F., Foppen M., Vlaar A.P., Muller M.CA., Bouman C.C.S., Beenen L.F.M., Kootte R.S., Heijmans J., Smits L.P, Bonta P.I., van Es N. Incidence of venous thromboembolism in hospitalized patients with COVID-19. J. Thromb. Haemost. 2020; 18 (8): 1995-2002. DOI: 10.1111/jth.14888
3. Prevention, diagnosis and treatment of new coronavirus infection (COVID-19). Interim guidelines (version 6): 28.04.2020 [In Russ.]. URL: https://static-1.rosminzdrav.ru/system/attachments/attac-hes/000/050/116/original/28042020_%D0%9CR_COVID-19_v6.pdf
4. Prevention, diagnosis and treatment of new coronavirus infection (COVID-19). Interim guidelines (version 7): 03.06.2020 [In Russ.]. URL: https://static-0.rosminzdrav.ru/system/attachments/attac-hes/000/050/584/original/03062020_%D0%9CR_COVID-19_v7.pdf
5. Prevention, diagnosis and treatment of new coronavirus infection (COVID-19). Interim guidelines (version 8): 03.09.2020 [In Russ.]. URL: https://static-0.minzdrav.gov.ru/system/attachments/at-taches/000/051/777/original/030902020_COVID-19_v8.pdf
6. Prevention, diagnosis and treatment of new coronavirus infection (COVID-19). Interim guidelines (version 8.1): 01.10.2020 [In Russ.]. URL: https://static-0.minzdrav.gov.ru/system/attachments/attac-hes/000/052/219/originaI/%D0%92%D1%80%D0%B5%D0%BC%D0%B5%D0%BD%D0%BD%D1%8B%D0%B5_%D0%9C%D0%A0_COVID-19_%28v.8.1%29.pdf?1601561462
7. Prevention, diagnosis and treatment of new coronavirus infection (COVID-19). Interim guidelines (version 9): 26.10.2020 [In Russ.]. URL: https://static-0.minzdrav.gov.ru/system/attachments/attac-hes/000/052/548/originaI/%D0%9C%D0%A0_COVID-19_%28v.9%29.pdf
8. Prevention, diagnosis and treatment of new coronavirus infection (COVID-19). Interim guidelines (version 10): 08.02.2021 [In Russ.]. URL: https://static-0.minzdrav.gov.ru/system/attachments/attac-hes/000/054/588/originaI/%D0%92%D1%80%D0%B5%D0%BC%D0%B5%D0%BD%D0%BD%D1%8B%D0%B5_%D0%9C%D0%A0_COVID-19_%28v.10%29-08.02.2021_%281%29.pdf
9. McBane R.D., Torres Roldan V.D., Niven A.S., Pruthi R.K., Franco P.M. AnticoaguIation in COVID-19: A Systematic Review, Meta-anaIysis, and Rapid Guidance From Mayo CIinic. Mayo Clin Proc. 2020; 95 (11): 2467-2486. DOI: 10.1016/j.mayocp.2020.08.030. Epub 2020 Aug 31.
10. Cuker A., Tseng E.K., Nieuwlaat R., Angchaisuksiri P, Blair C., Dane K., Davila J., DeSancho M.T., Diuguid D., Griffin D.O., Kahn S.R., Klok FA., Lee A.I., Neumann I., Pai A., Pai M., Righini M., Sanfilippo K.M., Siegal D., Skara M., Tour K., Akl EA., Akl I.B., Boulos M., Brignardello-Petersen R., CharideR., Chan M., DearnessK., Darzi A.J., Kolb Ph., Col-unga-Lozano L.E., Mansour R., Morgano G.P., Morsi R.Z., Noori A., Pig-gott T., Qiu Y., Roldan Y., Schunemann F., Stevens A., Solo K., Ventresca M., Wiercioch W., Mustafa R.A., Holger J., Schunemann H.J. American Society of Hematology 2021 guidelines on the use of anticoagulation for thromboprophyIaxis in patients with COVID-19. Blood Advances. 2021; 5 (31): 872-888, ISSN 2473-9529, DOI: 10.1182/bIoodadvan-ces.2020003763.
11. WorId HeaIth Organization. CIinicaI management of COVID-19: Ii-ving guidance. 25.01.2021. WHO/2019-nCoV/cIinicaI/2021.1 URL: https: //www.who.int/pubIications/i/item/WHO-2019-nCoV-cIini-caI-2021-1
12. COVID-19 Treatment PaneI. Coronavirus Disease 2019 (COVID-19) Treatment GuideIines. NationaI Institutes of HeaIth. URL: https: //www.covid19treatmentguideIines.nih.gov/
13. Chen A., Stecker E., Warden B.A. Direct Oral Anticoagulant Use: A PracticaI Guide to Common CIinicaI ChaIIenges. J Am Heart Assoc. 2020; 9 (13): e017559. DOI: 10.1161/JAHA.120.017559.
14. Sikorska J., Uprichard J. Direct Oral Anticoagulants: A Quick Guide. Eur Cardiol. 2017; 12 (1): 40-45. DOI: 10.15420/ecr.2017: 11: 2.
15. Bauersachs R., Berkowitz S.D., Brenner B., Buller H.R., Decousus H., GallusA.S., Lensing A.W., MisselwitzF., PrinsM.H., Raskob G.E., Segers A., Verhamme P., Wells P., Agnelli G., Bounameaux G., Cohen A., Davidson B.L., Piovella F, Schellong S.; The EINSTEIN Investigators. Oral Rivaroxaban for Symptomatic Venous ThromboemboIism. N Engl J Med. 2010; 363: 2499-2510. DOI: 10.1056/NEJMoa1007903
16. Agnelli G., Buller H.R., Cohen A., Curto M., Gallus A.S., Johnson M., Masiukiewicz U., Pak R., Thompson J., Raskob G.E., Weitz J.I.; AMPLIFY Investigators. Oral apixaban for the treatment of acute venous thromboemboIism. N Engl J Med. 2013; 369 (9): 799-808. DOI: 10.1056/NEJMoa1302507. Epub 2013 Jul 1. PMID: 23808982.
17. Otdelenov V.A., Mirzaev K.B., Sychev D.A. The possibility of using direct oral anticoagulants for the prevention of thromboembolic events in patients with COVID-19. Kachestvennaya klinicheskaya praktika. 2020; S4: 18-22 [In Russ.]. DOI: 10.37489/2588-0519-2020-S4-18-22
18. Chasek-Saslavsky S., Hernandaz-PerezA.L., Moguel R., Gallardo-Her-nandez A.G. Safe and effective early start of oral anticoagulant therapy in ambuIatory patients with COVID-19. Cardiovasc Metab Sci. 2021. 32 (1): 9-15. DOI: 10.35366/98225
19. RoitmanE.V., Vavilova T.V., Markin S.M., KravtsovP.F., MazaishviliK.V. Realities of the use of anticoagulant therapy in COVID-19. Tromboz, gemostaz i reologiya. 2021. 84: 18-26 [In Russ.]. DOI: 10.25555/THR.2021.1.0957
20. The University of Liverpool’s list of drug interactions https: //covid19-druginteractions.org/checker
21. American Society of HematoIogy. COVID-19 and VTE /AnticoaguIa-tion: FrequentIy Asked Questions (Version 9.0; Iast updated February 25, 2021) URL: https: //www.hematoIogy.org/covid-19/covid-19-and-vte-anticoaguIation.
Review
For citations:
Ni O.G., Troshchansky D.V., Protsenko D.N., Tyurin I.N., Balanyuk E.A. Efficacy and Safety of Oral Anticoagulants in the Treatment of COVID-19. General Reanimatology. 2021;17(3):42-49. https://doi.org/10.15360/1813-9779-2021-3-42-49
Views:
6695
Email this article 