Clinical question: Should extended post-discharge venous thromboembolism (VTE) prophylaxis be prescribed for patients with COVID-19?
Background: While VTE prophylaxis during hospitalization for COVID-19 is widely recommended, the role of extended, post-discharge VTE prophylaxis is unclear.
Study design: Open-label, multicenter, randomized trial
Setting: 14 centers in Brazil
Synopsis: 320 patients hospitalized with COVID-19 and at increased risk for VTE (IMPROVE score ≥4 or 2-3 plus D-dimer >500 ng/mL) were randomized to receive rivaroxaban 10 mg daily or no anticoagulation for 35 days after discharge. Patients were monitored for symptomatic VTE and underwent bilateral lower extremity doppler ultrasound and computed tomography pulmonary angiogram on day 35 to evaluate for asymptomatic VTE. The primary efficacy outcome, a composite of thromboembolism events, occurred in 3% of the rivaroxaban group versus 9% of the control group (RR 0.33, 95% CI 0.12-0.9; P=0.0293). No major bleeding occurred in either group.
Bottom line: In patients at high risk for VTE, prophylactic rivaroxaban for 35 days after hospitalization for COVID-19 improved clinical outcomes.
Citation: Ramacciotti E, et al. Rivaroxaban versus no anticoagulation for post-discharge thromboprophylaxis after hospitalization for COVID-19 (MICHELLE): an open-label, multicentre, randomized, controlled trial. Lancet. 2022;399:50-59.
Dr. Indovina is a hospitalist at Denver Health, Denver, and an assistant professor in the division of internal medicine, at the University of Colorado School of Medicine.