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.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/effect-of-dexamethasone-on-direct-oral-anticoagulant-plasma-levels-in-patients-with-covid-19/