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Yakugaku Zasshi ; 142(10): 1125-1127, 2022.
Article in Japanese | MEDLINE | ID: covidwho-2054202


A 55-year-old man with hypertrophic cardiomyopathy and a pacemaker was admitted with coronavirus disease 2019 (COVID-19). Before admission, the patient's medications included amiodarone, diltiazem, bisoprolol, atorvastatin, etizolam, and warfarin (WF). After admission, dexamethasone (DXM) and remdesivir (RDV) were initiated for treating COVID-19. The international normalized ratio (INR) on admission was 1.8, which increased to 3.4 on day 5 and to 6.9 on day 10 after admission. Although there have been reports that RDV may occasionally prolong prothrombin time and that the degree of prolongation is often less severe, the mechanism of action has not been elucidated till date. There are reports of prolonged INR when WF is co-administered with RDV and DXM, suggesting that drug interactions may be a potential cause for the prolongation. A similar drug interaction may have potentially occurred in the case reported here. In addition, this case used amiodarone (AMD), and it has been reported that the RDV concentration increases when used in combination with AMD. Further investigations are needed to elucidate the cause of INR prolongation. Thus, close monitoring of the patient is recommended when RDV is co-administered with high-risk agents to avoid unnecessary side effects.

Amiodarone , COVID-19 Drug Treatment , Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , Amiodarone/adverse effects , Anticoagulants/pharmacology , Atorvastatin , Bisoprolol , Dexamethasone/adverse effects , Diltiazem , Drug Interactions , Humans , International Normalized Ratio , Male , Middle Aged , Warfarin/pharmacology
Clin Appl Thromb Hemost ; 27: 10760296211021495, 2021.
Article in English | MEDLINE | ID: covidwho-1277870


The treatment process of patients using warfarin is expected to be hindered during the COVID-19 pandemic. Therefore we investigated whether the time in therapeutic range (TTR) and bleeding complications were affected during the COVID-19 pandemic. 355 patients using warfarin were included between March 2019 to March 2021. Demographic parameters, INR (international normalized ratio), and bleeding rates were recorded retrospectively. The TTR value was calculated using Rosendaal's method. The mean age of the patients was 61 ± 12 years and 55% of them were female. The mean TTR value during the COVID-19 pandemic was lower than the pre-COVID-19 period (56 ± 21 vs 68 ± 21, P < 0.001). Among the patients, 41% had a lack of outpatient INR control. During the COVID-19 pandemic, 71 (20%) patients using VKA suffered bleeding. Among patients with bleeding, approximately 60% did not seek medical help and 6% of patients performed self-reduction of the VKA dose. During the COVID-19 pandemic, TTR values have decreased with the lack of monitoring. Furthermore, the majority of patients did not seek medical help even in case of bleeding.

Anticoagulants/pharmacology , Bleeding Time , Blood Coagulation/drug effects , COVID-19/blood , Hemorrhage/chemically induced , International Normalized Ratio , Pandemics , SARS-CoV-2 , Thrombophilia/blood , Warfarin/pharmacology , Aged , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Anticoagulants/therapeutic use , Atrial Fibrillation/complications , Atrial Fibrillation/drug therapy , COVID-19/complications , Dose-Response Relationship, Drug , Female , Heart Valve Prosthesis/adverse effects , Hemorrhage/psychology , Humans , Hypertension/complications , Male , Medication Adherence , Middle Aged , Patient Acceptance of Health Care , Pulmonary Embolism/drug therapy , Retrospective Studies , Self Medication , Thrombophilia/drug therapy , Thrombophilia/etiology , Warfarin/administration & dosage , Warfarin/adverse effects , Warfarin/therapeutic use