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Effect of Dexamethasone on Direct Oral Anticoagulant Plasma Levels in Patients with COVID-19

F. Bosch1,2, M. Candeloro3, N. Potere3, E. Porreca3, M. Di Nisio3, P.W. Kamphuisen1,2

1Tergooi Hospitals, Hilversum, Netherlands, 2Amsterdam UMC, Location AMC, Amsterdam, Netherlands, 3Gabriele D'Annunzio University, Chieti, Italy

Abstract Number: PB0231

Meeting: ISTH 2021 Congress

Theme: COVID and Coagulation » COVID and Coagulation, Clinical

Background: Dexamethasone is part of the standard treatment of COVID-19 patients who need oxygen support. COVID-19 patients have a high risk of venous and arterial thrombosis, therefore adequate anticoagulation is of vital importance. Direct oral anticoagulants (DOACs) are generally not recommended in patients with dexamethasone due to possible drug-drug interactions which may decrease DOACs plasma levels. Therefore, data on the interaction between dexamethasone and DOACs is urgently needed.

Aims: To assess DOAC plasma levels in patients with simoultaneous use of dexamethasone.

Methods: Trough and peak DOAC plasma levels, by means of anti-activated factor X (anti-Xa) were prospectively collected in hospitalized COVID-19 patients treated with dexamethasone and DOACs (apixaban, rivaroxaban and edoxaban) and in hospitalized COVID-19 patients treated with DOACs only, to assess whether these values were within reference range.

Results: Data were collected across two centres in Italy and the Netherlands. A total of 20 patients, 16 with DOACs and dexamethasone and 4 with DOACs only were enrolled. Twelve patients were on anticoagulant treatment for atrial fibrillation, seven for venous thromboembolism, and one for myocardial infarction. In 15 patients DOACs were started during the hospitalization. None of the patients had trough DOAC plasma levels below reference range. Only one patient (6.3%) treated with rivaroxaban had peak levels below reference range. Six patients (37.5%) in the dexamethasone group and two control patients (50%) had peak or trough DOAC plasma levels above reference range.

Dexamethasone use DOAC dose Indication New/chronic users Age Sex Weight (kg) eGFR (mL/min) DOAC
trough level (ng/mL)
DOAC
peak level (ng/mL)
Yes Apixaban
2.5mg bid
AF
AF
AF
New
New
New
88
95
80
M
M
M
78
66
79
35
19
56
179 (high)
36
150
227 (high)
69
170
Apixaban
5mg bid
AF
VTE
Chronic
New
84
66
F
M
109
87
80
132
122
32
182
110
Apixaban
10mg bid
VTE New 82 M 69 41 192 308
Rivaroxaban
10mg od
Post AMI Chronic 78 M 78 82 41 (high) 125
Rivaroxaban
15mg od
AF New 86 F 67 43 52 283
Rivaroxaban
20mg od
AF
AF
AF
AF
Chronic
New
New
New
86
83
74
71
M
M
M
M
68
90
110
116
66
89
75
90
81
64
76
26
545 (high)
306
263
158 (low)
Rivaroxaban
15mg bid
VTE New 77 F 62 88 79 256
Edoxaban
60mg od
VTE
VTE
VTE
Chronic
New
New
79
84
72
M
F
M
94
76
80
61
61
90
64 (high)
35
28
347 (high)
388 (high)
223
No Apixaban
2.5mg bid
AF
AF
AF
New
Chronic
New
85
90
73
F
M
M
62
73
96
23
43
28
99
85
107
121
91
156
Apixaban
10mg bid
VTE New 60 M 88 82 61 286

DOAC plasma levels and characteristics per patient

Conclusions: In COVID-19 patients, the effect of dexamethasone use on DOAC plasma levels seems limited. This suggests that DOACs can be safely started or continued in COVID-19 patients treated with dexamethasone.

To cite this abstract in AMA style:

Bosch F, Candeloro M, Potere N, Porreca E, Di Nisio M, Kamphuisen PW. Effect of Dexamethasone on Direct Oral Anticoagulant Plasma Levels in Patients with COVID-19 [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/effect-of-dexamethasone-on-direct-oral-anticoagulant-plasma-levels-in-patients-with-covid-19/. Accessed December 6, 2023.

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