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Oral anticoagulation with rivaroxaban as thromboprophylaxis in patients recovered from COVID-19 pneumonia in Veracruz, Mexico


Journal of Anesthesia & Critical Care: Open Access
Luis Del Carpio-Orantes,1 Sergio GarcíaMendez,2 Jesús Salvador Sánchez-Díaz,3 Karla Gabriela Peniche-Moguel,3 Elisa Estefanía Aparicio-Sánchez,1 Orlando Israel Segura-Rodríguez,1 Andrés AguilarSilva,1 Omar García-Hernández,1 Alejandro Escobar-Huerta,1 Azael Ahumada-Zamudio,1 Andrés Realino Velasco-Caicero,1 Olga González-Segovia,1 Ernesto Javier PachecoPérez,1 Álvaro Efrén Munguia-Sereno,1 Edna Rosario Contreras-Sánchez,1 Sara Nohemí Hernández-Hernández,1 Luis Jaime Medrano-Rios,1 Ada Lili Rosas-Lozano4

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Abstract

Background: Patients affected by COVID-19 are at risk of various venous and arterial thrombotic events, as well as embolic risks, the risk can vary from 17% to 78% according to the different published series. Therefore, thromboprophylaxis must be imperative. Methods: Descriptive and analytical study in patients who presented pneumonia due to COVID-19 in April and May 2020, who received LMWH during their hospital stay and at discharge with rivaroxaban 10 mg / day for 2 months. D-dimer was measured at the beginning of the study and 1 month after discharge. Thrombotic or hemorrhagic episodes are controlled after 1 and 2 months of treatment (June – July 2020). Results: 50 patients are included, twenty women (40%) and thirty (60%) men, with a median age of 42.9 years. 32 (64%) patients had mild pneumonia and 18 (36%) patients had severe pneumonia, mean initial d-dimer 556.5 (375.2 - 1233.7) ng / ml, 56% of patients had d-dimer ≥ 500 ng / ml at the time of hospital admission. Baseline D-dimer values were significantly higher among patients with severe pneumonia. In the follow-up at one and two months after hospital discharge, we found that D-dimer values were significantly higher among patients with severe pneumonia and also, in this group of patients, the percentage of patients with D-dimer levels ≥ 500 ng / mL in the first month of follow-up, was significantly higher in the group of patients who were hospitalized for severe pneumonia. During the first month of follow-up, there was a thrombotic event and a hemorrhagic event in the group of patients with a history of severe pneumonia; by the second month of follow-up, there was a hemorrhagic event in the group of patients with mild pneumonia, but this difference in frequencies was not statistically significant. Conclusion: In this group of patients, the incidence of thrombotic and hemorrhagic events was low, so the thromboprophylaxis scheme used in patients with recovered pneumonia due to COVID-19 is recommended. Rivaroxaban is safe to use like thromboprophylaxis

Keywords

rivaroxaban, thromboprophylaxis, COVID-19

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