rivaroxaban and Pneumonia--Viral

We report 3 patients with coronavirus disease who had a decline in respiratory status during their hospital course that responded well to intravenous steroids and interleukin-6 receptor antagonist therapy. These patients later showed development of persistent hypoxia with increased levels of d-dimer levels and were given a diagnosis of pulmonary embolisms.

Topics: Acute Disease; Aged; Antibodies, Monoclonal, Humanized; Anticoagulants; Betacoronavirus; Biomarkers; Clinical Laboratory Techniques; Coronavirus Infections; COVID-19; COVID-19 Testing; Cytokine Release Syndrome; Enoxaparin; Female; Fibrin Fibrinogen Degradation Products; Humans; Hypoxia; Male; Methylprednisolone Hemisuccinate; Middle Aged; Pandemics; Pneumonia, Viral; Pulmonary Embolism; Rivaroxaban; SARS-CoV-2; Tomography, X-Ray Computed; Treatment Outcome

Topics: Anticoagulants; Betacoronavirus; Coronavirus; Coronavirus Infections; COVID-19; Humans; Neoplasms; Pandemics; Pneumonia, Viral; Rivaroxaban; SARS-CoV-2; Thrombosis; Venous Thromboembolism

The Coronavirus Disease 2019 (COVID 19) has been reported in almost every country in the world. Although a large proportion of infected individuals develop only mild symptoms or are asymptomatic, the spectrum of the disease among others has been widely variable in severity. Additionally, many infected individuals were found to have coagulation markers abnormalities. This is especially true among those progressing to severe pneumonia and multi-organ failure. While the incidence of venous thromboembolic (VTE) disease has been recently noted to be elevated among critically ill patients, the incidence among ambulatory and non-critically ill patients is not yet clearly defined. Herein, we present six patients who didn't have any hypercoagulable risk factors yet presented with pulmonary embolism in association with COVID 19 infection. Furthermore, we discuss the possible underlying mechanisms of hypercoagulability and highlight the possibility of underdiagnosing pulmonary embolism in the setting of overlapping symptoms, decreased utilization of imaging secondary to associated risks, and increased turnover times. In addition, we emphasize the role of extended thromboprophylaxis in discharged patients.

Topics: Adult; Aged; Anticoagulants; Betacoronavirus; Coronavirus Infections; COVID-19; Enoxaparin; Female; Fibrinolytic Agents; Humans; Male; Middle Aged; Pandemics; Pneumonia, Viral; Pulmonary Embolism; Pyrazoles; Pyridones; Rivaroxaban; SARS-CoV-2; Tissue Plasminogen Activator

Infection caused by SARS-CoV-2 (COVID-19) is associated with an increased risk of thromboembolic disease. So-me authors recommend anticoagulation at therapeutic doses for, at least, the most severely ill patients; this practice is not free of risks, which is why only thromboembolic prophylaxis is recommended by other consensuses. In the case of previously anticoagulated patients, changing the oral anticoagulant for a low molecular weight heparin (LMWH) is generally recommended. We present the cases of two patients admitted due to COVID-19, without serious clinical data, in whom anticoagulation (acenocoumarol and rivaroxaban, respectively) was replaced by LMWH at therapeutic doses, both presenting abdominal bleeding. This type of bleeding is an infrequent complication in anticoagulated patients, but the concurrence of two cases in a short period of time in the context of the COVID-19 pandemic leads us to consider that there is not yet any clear evidence on therapeutic anticoagulation in SARS-CoV-2 infection.

Topics: Abdomen; Acenocoumarol; Aged, 80 and over; Anticoagulants; Betacoronavirus; Coronavirus Infections; COVID-19; Female; Hematoma; Heparin, Low-Molecular-Weight; Humans; Pandemics; Pneumonia, Viral; Rivaroxaban; SARS-CoV-2; Venous Thromboembolism