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Patients who are hospitalized with COVID-19 have elevated rates of postdischarge thrombotic events, but uncertainty exists about whether thromboprophylaxis should continue beyond the hospital stay. In a recent phase 3 trial, continuing thromboprophylaxis after patients hospitalized with COVID-19 were discharged reduced major and fatal thromboembolic events without increasing major bleeding.
The trial randomized 320 patients hospitalized with COVID-19 at centers in Brazil to 10-mg/d rivaroxaban or no anticoagulation for 35 days after discharge. All patients received thromboprophylaxis while hospitalized and were at high risk of venous thromboembolism at discharge.
At day 35, about 3% of the rivaroxaban group and about 9% of the control group had an efficacy outcome event, a composite of venous and arterial thromboembolism and cardiovascular death. No major bleeding occurred in either group. Two patients in the rivaroxaban group experienced allergic reactions. The findings appeared in The Lancet.
Published Online: February 2, 2022. doi:10.1001/jama.2022.1533
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Rivaroxaban 10-mg/d was used in this trial, however there is much debate regarding the optimal dosage regimen and duration of extended VTE prophylaxis.
This trial of 320 patients provides useful information but is not sufficient to provide high-quality evidence on the role of extended VTE prophylaxis.
Slomski A. Extending Rivaroxaban After COVID-19 Hospitalization. JAMA. 2022;327(8):710. doi:10.1001/jama.2022.1533
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