Direct oral anticoagulant plasma levels striking increase in severe COVID‐19 respiratory syndrome patients treated with antiviral agents. The Cremona experience
ISTH Academy. Testa S. 04/23/20; 293465
Dr. Sophie Testa
Contributions
Contributions
Journal Abstract
Summary
Background
Antiviral drugs are administered in patients with severe COVID‐19 respiratory syndrome (SARS‐CoV‐2), including those treated with direct oral anticoagulants (DOACs). Concomitant administration of antiviral agents has the potential to increase their plasma concentration. A series of patients managed in the Cremona Thrombosis Center were admitted at Cremona Hospital for SARS‐CoV‐2 and started antiviral drugs without stopping DOAC therapy. DOAC plasma levels were measured in‐hospital and results compared with those recorded before hospitalization. Methods
All consecutive patients on DOACs were candidates for administration of antiviral agents (lopinavir, ritonavir or darunavir). Plasma samples for DOAC measurement were collected 2‐4 days after starting antiviral treatment, at 12 hours from the last dose intake in patients on dabigatran and apixaban, and at 24 hours in those on rivaroxaban and edoxaban. For each patient, C‐trough DOAC level , expressed as ng/mL, was compared with the one measured before hospitalization. Results
Of the 1039 patients hospitalized between February 22th and March 15th 2020 with SARS‐CoV‐2 and candidates for antiviral therapy, 32 were on treatment with a DOAC. DOAC was stopped in 20, and continued in the remaining 12. On average, C‐trough levels were 6.14 times higher during hospitalization than in pre‐hospitalization period. Conclusion
DOAC patients treated with antiviral drugs show an alarming increase in DOAC plasma levels. In order to prevent bleeding complications, we believe that physicians should consider withholding DOACs from patients with SARS‐CoV‐2 and replacing them with alternative parenteral antithrombotic strategies for as long as antiviral agents are deemed necessary and until discharge.
Background
Antiviral drugs are administered in patients with severe COVID‐19 respiratory syndrome (SARS‐CoV‐2), including those treated with direct oral anticoagulants (DOACs). Concomitant administration of antiviral agents has the potential to increase their plasma concentration. A series of patients managed in the Cremona Thrombosis Center were admitted at Cremona Hospital for SARS‐CoV‐2 and started antiviral drugs without stopping DOAC therapy. DOAC plasma levels were measured in‐hospital and results compared with those recorded before hospitalization. Methods
All consecutive patients on DOACs were candidates for administration of antiviral agents (lopinavir, ritonavir or darunavir). Plasma samples for DOAC measurement were collected 2‐4 days after starting antiviral treatment, at 12 hours from the last dose intake in patients on dabigatran and apixaban, and at 24 hours in those on rivaroxaban and edoxaban. For each patient, C‐trough DOAC level , expressed as ng/mL, was compared with the one measured before hospitalization. Results
Of the 1039 patients hospitalized between February 22th and March 15th 2020 with SARS‐CoV‐2 and candidates for antiviral therapy, 32 were on treatment with a DOAC. DOAC was stopped in 20, and continued in the remaining 12. On average, C‐trough levels were 6.14 times higher during hospitalization than in pre‐hospitalization period. Conclusion
DOAC patients treated with antiviral drugs show an alarming increase in DOAC plasma levels. In order to prevent bleeding complications, we believe that physicians should consider withholding DOACs from patients with SARS‐CoV‐2 and replacing them with alternative parenteral antithrombotic strategies for as long as antiviral agents are deemed necessary and until discharge.
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