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J Clin Pharm Ther . Breakthrough venous thromboembolic events in five patients with COVID-19 on direct oral anticoagulants

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  • J Clin Pharm Ther . Breakthrough venous thromboembolic events in five patients with COVID-19 on direct oral anticoagulants


    J Clin Pharm Ther


    . 2020 Nov 20.
    doi: 10.1111/jcpt.13311. Online ahead of print.
    Breakthrough venous thromboembolic events in five patients with COVID-19 on direct oral anticoagulants


    Paul Lewis 1 , Jennifer L Tharp 1



    Affiliations

    Abstract

    What is known and objective: Coronavirus disease 2019 (COVID-19) is associated with increased risk of venous thromboembolism (VTE). Guidance for VTE prophylaxis continues to evolve, including addressing direct oral anticoagulants (DOACs) continued upon hospitalization.
    Case summaries: We present 5 patients hospitalized for COVID-19 while on DOACs. Four patients had atrial fibrillation and had a previous VTE. Four patients developed acute VTE and one developed stroke-like symptoms. Monitoring D-dimer assisted with the detection of VTE. Three patients died, and two were discharged alive.
    What is new and conclusion: Therapeutic failure with DOACs appears to be commonplace in COVID-19. Further research is needed to determine whether there is an underlying cause to this association.

    Keywords: SARS-CoV-2; factor Xa Inhibitors; heparin; low molecular weight; pulmonary embolism.

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