In a recent publication in the journal, TH Open, Wenzler et al reported results of a single-center, retrospective cohort study that included 21 patients in an intensive-care unit (ICU) with severe COVID-19 infections treated with apixaban for atrial fibrillation (AFib), venous thromboembolism (VTE), catheter-induced thrombosis, and/or COVID-19–induced coagulopathy. The primary objective was to assess the prevalence of bleeding events, and secondary objectives included thromboembolic events, coagulation parameters, and mortality.

The researchers found that 90% of patients were nonwhite, 43% were obese, 90% had acute respiratory distress syndrome, and 76% required mechanical ventilation. Almost half of (47.6%) also experienced renal dysfunction and required renal replacement therapy. Eighty-six percent of patients received prophylaxis or treatment with unfractionated heparin or low molecular weight heparin within the 24-hour period prior to apixaban initiation. Patients were started on apixaban for the treatment of suspected or confirmed VTE (67%) or AFib (33%). All coagulation parameters remained abnormal but stable throughout the 10-day monitoring period. Results from the study indicated that no patients experienced major bleeding events or thrombosis throughout the study period. They also noted four deaths during the follow-up period, all believed to be unrelated to coagulopathy or bleeding.

The scientists also noted that this study adds to the current data assessing the best possible strategies for anticoagulation in patients with COVID-19-induced coagulopathy and expands on these data by assessing the use of apixaban in this high-risk ICU population for the first time. Moreover, the researchers indicated that their study included several fundamental limitations, such as small sample size, retrospective, single-arm nature, and relatively short follow-up period. They also stated that regardless of these limitations, to their knowledge, their study was the first set of clinical data assessing the use of direct oral anticoagulants, particularly apixaban, in ICU patients with severe COVID-19-related disease.

The study results led researchers to conclude that apixaban appeared safe and efficacious in ICU patients with severe COVID-19 disease, and that the data encourages future trials exploring the potential to augment anticoagulation strategies in patients with severe COVID-19. 

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