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Extended therapeutic-level prophylactic anticoagulation with rivaroxaban (Xarelto) for COVID-19 patients with elevated D-dimer levels wasn t better and carried more bleeding risk than lower hospital-only doses, the ACTION trial showed.
Standard prophylactic-level dosing actually won on mortality, duration of hospitalization, and duration of oxygen use through 30 days more often compared with the more intensive regimen, reported Renato Lopes, MD, PhD, of the Duke Clinical Research Institute in Durham, North Carolina, at the virtual American College of Cardiology (ACC) meeting.
The trial randomized 615 patients to a standard approach of in-hospital prophylactic-dose anticoagulation or to a strategy with rivaroxaban (20 mg daily in hospital) if stable or enoxaparin (1 mg/kg twice daily) if unstable while in the hospital then rivaroxaban continued through day 30 whether still in the hospital or discharged home.
Therapeutic Rivaroxaban: Risk Outweighs Benefit in Stable COVID medscape.com - get the latest breaking news, showbiz & celebrity photos, sport news & rumours, viral videos and top stories from medscape.com Daily Mail and Mail on Sunday newspapers.
May 17, 2021
Therapeutic-dose anticoagulation primarily consisting of rivaroxaban (Xarelto; Bayer/Janssen), compared with standard thromboprophylaxis, does not improve outcomes in patients hospitalized with COVID-19 who have elevated D-dimer levels, according to results from the randomized ACTION trial.
A “win ratio” analysis indicated that full-dose anticoagulation was no better, and potentially worse, than usual care in terms of a hierarchical composite endpoint of mortality, duration of hospitalization, and duration of oxygen use through 30 days, Renato Lopes, MD, PhD (Duke Clinical Research Institute, Durham, NC), reported over the weekend during the virtual American College of Cardiology 2021 Scientific Session.
A composite of thromboembolic events occurred at a numerically but nonsignificantly lower rate in the therapeutic-dose group (7.4% vs 9.9%), although that was offset by a nonsignificant increase in all-cause mortality (11.3% vs 7.6%) and a substantial and signific
2020 Wrap-up: COVID-19 s Effects on Cardiology medscape.com - get the latest breaking news, showbiz & celebrity photos, sport news & rumours, viral videos and top stories from medscape.com Daily Mail and Mail on Sunday newspapers.
January 13, 2021
Another randomized trial, REPLACE COVID, indicates that patients already taking ACE inhibitors and ARBs when they’re hospitalized for COVID-19 should continue to do so, supporting recommendations from international CV societies.
When it came to outcomes including all-cause death, duration of mechanical ventilation, time on renal replacement or vasopressor therapy, and multiorgan dysfunction during hospitalization, there were no differences between patients who continued versus discontinued their renin-angiotensin-aldosterone-system (RAAS) inhibitors after they were admitted, researchers report in a study published online last week in the
Lancet Respiratory Medicine.
More of TCTMD s coverage on our COVID-19 hub.
Considering these findings and those from the BRACE CORONA trial, presented last year at the virtual European Society of Cardiology Congress, the message is simple, according to senior author Julio Chirinos, MD, PhD (University of Pennsylvania, Philade