Use of direct oral anticoagulants (DOACs) in prevention or treatment of Pulmonary Embolism (PE) associated with COVID-19 pneumonia in ambulatory patients: Experience of an Argentine center

ABSTRACT

Background: Thrombotic events are frequent in COVID-19 patients. The use of DOACs to treatment or extended prophylaxis is not clear in these population. Aim(s) To know the prevalence of PE associated with COVID-19 pneumonia in our population. To describe the use of DOACs for ambulatory prophylaxis after COVID-19 pneumonia patients. To describe the use of DOACs for ambulatory treatment in PE COVID-19 patients. Method(s) Retrospective registry of patients admitted for COVID-19 pneumonia from May 2020 to December 2021. Internists evaluated thrombosis risk after discharge according to IMPROVE score and body mass index (BMI) >=30 following a local guideline. Exclusion criteria Treatment with other anticoagulants, no follow-up, death. Statistics Quantitative data through parametric analysis of variance and categorical data according to contingency tables Results: 345 patients were admitted;279 were evaluable (Table 1). 37.5% patients received extended prophylaxis (87/232 54 Apixaban, 33 Rivaroxaban). Mean prophylaxis time 14.27 days (7-28). There was no consensus among internists regarding prescribing ambulatory prophylaxis. 16.8% of COVID-19 pneumonias had PE (47/279). 70% were incidental (imaging studies due to underlying disease) and 30% were symptomatic. 38 were on Apixaban, 9 on Rivaroxaban. The mean days on anticoagulation treatment was 92 days (20-80). We had 4 thrombosis after discharge (Table 2). We have not recurrent thrombosis in the PE group. Bleeding events occurred in 3 cases on therapeutic doses. Only one was a major bleeding (hematuria). Conclusion(s) Our prevalence of PE in COVID-19 pneumonia was 16.8%. With respect to DOACs treatment we have not bleeding at prophylaxis doses and one mayor bleeding at therapeutic doses. We have four thrombosis after discharge. No recurrent thrombosis was seen in PE patients. The use of DOACs in extended prophylaxis or treatment after COVID-19 pneumonia seems to be safe, with no differences with the non-COVID- 19 population. (Table Presented).