Are drug-drug interactions clinically relevant?. Use of edoxaban concomitant to ritonavir in COVID-19 hospitalized patients with atrial fibrillation

P. Olivera¹, D. Campoy¹, C. Velásquez-Escandón², T. Canals³, K. Flores⁴, E. Johansson⁴, C. Hernandez⁵, O. Benitez⁵

¹Thrombosis and Hemostasis Unit. Department of Hematology, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain, ²Department of Hematology, Fundación Sanitària Mollet, Barcelona, Catalonia, Spain, ³⁶. Department of Hematology, University Hospital Sant Joan de Reus, Tarragona, Tarragona, Catalonia, Spain, ⁴⁵. Department of Hematology, General University Hospital of Catalonia, Barcelona, Barcelona, Catalonia, Spain, ⁵Thrombosis and Hemostasis Unit Department of Hematology, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain

Abstract Number: PB0080

Meeting: ISTH 2022 Congress

Theme: COVID and Coagulation » COVID and Coagulation, Clinical

Background: During the first wave of the SARS-CoV-2 pandemic, management of anticoagulation therapy in hospitalized patients with atrial fibrillation (AF) was simplified to low-molecular-weight heparin (LMWH), mainly due to the risk of drug-drug interactions. However, not all potential drug-drug interactions are clinically relevant. The metabolism of edoxaban by CYP3A4 is less than 4%, the risk of drug-drug interactions with edoxaban is low. There are few data on the interaction between edoxaban and ritonavir.

Aims: To determine whether the effectiveness and safety of edoxaban or LMWH differed between patients with AF who had been hospitalized for COVID-19 infection and received empirical treatment with ritonavir. In addition, we analyzed length of stay, the proportion of patients requiring admission to the intensive care unit, and mortality.

Methods: Observational, retrospective, and multicenter study that consecutively included hospitalized patients with non-valvular AF who received anticoagulant treatment with LMWH or edoxaban concomitantly with empirical therapy for COVID-19 infection.

Results: From March 5th to April 27th, 2020, 464 patients were included (80.3±7.7 years, 50.0% men, CHA2DS2-VASc 4.1±1.4; HAS-BLED 2.6±1.0). Regarding COVID-19 therapy during hospitalization, patients were taking azithromycin (98.7%), hydroxychloroquine (89.7%), and ritonavir/lopinavir (81.5%). The mean length of hospital stay was 14.6±7.2 days and mean total follow-up (from admission to the last visit) was 31.6±13.4 days. Furthermore, 12.9% of patients required admission to the intensive care unit, 18.5% of patients died, and 9.9% had a bleeding complication (34.8% major bleeding). Except for length of hospital stay, which was longer in patients taking LMWH (16.0±7.7 vs 13.3±6.5 days; P=0.005), data for the remaining outcomes were similar in patients treated with edoxaban and those treated with LMWH.

Conclusion(s): No significant differences were found between patients treated with edoxaban and patients treated with LMWH in terms of the percentage admitted to the intensive care unit, mortality rates, arterial and venous thromboembolic complications, and bleeds.

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Survival curves according to treatment -edoxaban vs LMWH-.

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Flow chart of the study

To cite this abstract in AMA style:

Olivera P, Campoy D, Velásquez-Escandón C, Canals T, Flores K, Johansson E, Hernandez C, Benitez O. Are drug-drug interactions clinically relevant?. Use of edoxaban concomitant to ritonavir in COVID-19 hospitalized patients with atrial fibrillation [abstract]. https://abstracts.isth.org/abstract/are-drug-drug-interactions-clinically-relevant-use-of-edoxaban-concomitant-to-ritonavir-in-covid-19-hospitalized-patients-with-atrial-fibrillation/. Accessed October 1, 2023.

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