Post-hospitalized patients, especially recently discharged coronavirus disease 2019 (COVID-19) patients, are at higher risk for major thromboembolic events or the formation of blood clots that could lead to death. New research published today in the Journal of the American College of Cardiology shows promise in the extended use of the drug rivaroxaban, a direct oral anticoagulant (DOAC), to prevent those adverse events.
A team of doctors and scientists from multiple international health care research institutes, led by Alex Spyropoulos, MD, professor at the Feinstein Institutes for Medical Research, (Northwell Health) analyzed the first set of data from a previous large clinical trial titled MARINER (NCT02111564). The team looked at the extended treatment of 10mg rivaroxaban for 45 days and if it reduced major arterial and venous thromboembolic events like venous thromboembolism (VTE), pulmonary embolism and stroke. Results showed that VTE, stroke, Myocardial infarction, and cardiovascular death were significantly reduced by 28 percent without an increase in major bleeding.
This study has particular relevance for hospitalized patients infected with the COVID-19 virus, as early research suggests those patients are prone to suffer arterial thromboembolism, including strokes and death, as well as venous thrombosis both in the hospital and after discharge.
“We are encouraged by the study’s results to potentially reduce these life-threatening thromboembolic episodes by expanding the use of rivaroxaban for patients post-hospitalization,” said Dr. Spyropoulos. “Through this research, Northwell Health has adapted its treatment policy for discharged COVID-19 patients, and others at risk, across the health system.”
In the trial, a total of 4,909 patients were assigned to the rivaroxaban treatment group and 4,913 patients in the placebo group. Additional results show that symptomatic lower extremity deep vein thrombosis (DVT) reduced 80 percent in those treated with rivaroxaban. In 2019, the Food and Drug Administration (FDA) approved a 10mg dose of rivaroxaban to treat hospitalized medically ill patients with extended thromboprophylaxis.
“Dr. Spyropoulos’ findings provide important guidance to significantly protect patients from potentially fatal clots,” said Kevin J. Tracey, MD, CEO and president of the Feinstein Institutes. “As a leader in this field, his new findings point the way to new standards of care at Northwell Health and likely other institutions worldwide.”