High-risk subgroups were not identified to benefit from thromboprophylaxis after hospitalization for COVID-19

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dc.contributor.authorBaumann Kreuziger, Lisaen
dc.contributor.authorKwon, Taeimen
dc.contributor.authorKasthuri, Raj S.en
dc.contributor.authorWahid, Lanaen
dc.contributor.authorMiller, Peter J.en
dc.contributor.authorEnders, Kimberlyen
dc.contributor.authorWahed, Abdus S.en
dc.contributor.authorAnstrom, Kevin J.en
dc.contributor.authorWang, Tracy Y.en
dc.contributor.authorOrtel, Thomas L.en
dc.date.accessioned2024-06-05T19:07:46Zen
dc.date.available2024-06-05T19:07:46Zen
dc.date.issued2024-05-01en
dc.description.abstractBackground: The Accelerating COVID-19 Therapeutic Interventions and Vaccines-4c (ACTIV-4c) trial investigated prophylactic apixaban for 30 days following hospitalization for COVID-19. The overall incidence of early postdischarge death or thromboembolism was low, and the trial was closed early. Objectives: To identify a high-risk patient population who might benefit from postdischarge thromboprophylaxis through subgroup analyses stratified by age, race/ethnicity, obesity, D-dimer elevation, World Health Organization score, and modified International Medical Prevention Registry on Venous Thromboembolism score on 30-day composite outcome of all-cause death, arterial thromboembolism (ATE), and venous thromboembolism (VTE). Methods: Cumulative incidences of all-cause death, ATE, and VTE within 30 days were described for each subgroup. Time to death, ATE, or VTE by 30 days was analyzed using Cox proportional hazard models with interaction testing for each subgroup. Results: Among 1217 patients randomized to apixaban or placebo group, 32% were >60 years old. Modified International Medical Prevention Registry on Venous Thromboembolism score was ≥4 in 2% and 2 or 3 with an elevated D-dimer in an additional 9% of participants. The overall incidence of the primary endpoint was 2.13% in the apixaban group and 2.31% in the placebo group. At day 30, similar rates of the primary endpoint occurred within subgroups, except for participants aged >60 years. No benefit of thromboprophylaxis was seen in any subgroup. Conclusion: The combined incidence of 30-day death, ATE, and VTE was low in patients who survived COVID-19 hospitalization, except in patients over age 60 years. Due to the limited number of events, the findings remain inconclusive; nonetheless, the study did not identify a high-risk subgroup that would derive benefits from extended thromboprophylaxis.en
dc.description.versionPublished versionen
dc.format.mimetypeapplication/pdfen
dc.identifier102417 (Article number)en
dc.identifier.doihttps://doi.org/10.1016/j.rpth.2024.102417en
dc.identifier.eissn2475-0379en
dc.identifier.issn2475-0379en
dc.identifier.issue4en
dc.identifier.orcidWahid, Lana [0000-0002-2160-3287]en
dc.identifier.urihttps://hdl.handle.net/10919/119297en
dc.identifier.volume8en
dc.language.isoenen
dc.publisherElsevieren
dc.rightsCreative Commons Attribution-NonCommercial-NoDerivatives 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/en
dc.subjectCOVID-19en
dc.titleHigh-risk subgroups were not identified to benefit from thromboprophylaxis after hospitalization for COVID-19en
dc.title.serialResearch and Practice in Thrombosis and Haemostasisen
dc.typeArticle - Refereeden
dc.type.dcmitypeTexten
dc.type.otherJournal Articleen
pubs.organisational-group/Virginia Techen
pubs.organisational-group/Virginia Tech/VT Carilion School of Medicineen
pubs.organisational-group/Virginia Tech/VT Carilion School of Medicine/Internal Medicineen
pubs.organisational-group/Virginia Tech/VT Carilion School of Medicine/Internal Medicine/General IMen

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