AUTHOR=Fiedler Lukas , Motloch Lukas J. , Dieplinger Anna-Maria , Jirak Peter , Davtyan Paruir , Gareeva Diana , Badykova Elena , Badykov Marat , Lakman Irina , Agapitov Aleksandr , Sadikova Liana , Pavlov Valentin , Föttinger Fabian , Mirna Moritz , Kopp Kristen , Hoppe Uta C. , Pistulli Rudin , Cai Benzhi , Yang Baofeng , Zagidullin Naufal 

TITLE=Prophylactic rivaroxaban in the early post-discharge period reduces the rates of hospitalization for atrial fibrillation and incidence of sudden cardiac death during long-term follow-up in hospitalized COVID-19 survivors

JOURNAL=Frontiers in Pharmacology

VOLUME=14

YEAR=2023

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2023.1093396

DOI=10.3389/fphar.2023.1093396

ISSN=1663-9812

ABSTRACT=<p><bold>Introduction:</bold> While acute Coronavirus disease 2019 (COVID-19) affects the cardiovascular (CV) system according to recent data, an increased CV risk has been reported also during long-term follow-up (FU). In addition to other CV pathologies in COVID-19 survivors, an enhanced risk for arrhythmic events and sudden cardiac death (SCD) has been observed. While recommendations on post-discharge thromboprophylaxis are conflicting in this population, prophylactic short-term rivaroxaban therapy after hospital discharge showed promising results. However, the impact of this regimen on the incidence of cardiac arrhythmias has not been evaluated to date.</p><p><bold>Methods:</bold> To investigate the efficacy of this therapy, we conducted a single center, retrospective analysis of 1804 consecutive, hospitalized COVID-19 survivors between April and December 2020. Patients received either a 30-day post-discharge thromboprophylaxis treatment regimen using rivaroxaban 10 mg every day (QD) (Rivaroxaban group (Riva); <italic>n</italic> = 996) or no thromboprophylaxis (Control group (Ctrl); <italic>n</italic> = 808). Hospitalization for new atrial fibrillation (AF), new higher-degree Atrioventricular-block (AVB) as well as incidence of SCD were investigated in 12-month FU [FU: 347 (310/449) days].</p><p><bold>Results:</bold> No differences in baseline characteristics (Ctrl vs Riva: age: 59.0 (48.9/66.8) vs 57 (46.5/64.9) years, <italic>p</italic> = <italic>n</italic>.s.; male: 41.5% vs 43.7%, <italic>p</italic> = <italic>n</italic>.s.) and in the history of relevant CV-disease were observed between the two groups. While hospitalizations for AVB were not reported in either group, relevant rates of hospitalizations for new AF (0.99%, <italic>n</italic> = 8/808) as well as a high rate of SCD events (2.35%, <italic>n</italic> = 19/808) were seen in the Ctrl. These cardiac events were attenuated by early post-discharge prophylactic rivaroxaban therapy (AF: <italic>n</italic> = 2/996, 0.20%, <italic>p</italic> = 0.026 and SCD: n = 3/996, 0.30%, <italic>p</italic> &lt; 0.001) which was also observed after applying a logistic regression model for propensity score matching (AF: <italic>χ</italic><sup>2</sup>-statistics = 6.45, <italic>p</italic> = 0.013 and SCD: <italic>χ</italic><sup>2</sup>-statistics = 9.33, <italic>p</italic> = 0.002). Of note, no major bleeding complications were observed in either group.</p><p><bold>Conclusion:</bold> Atrial arrhythmic and SCD events are present during the first 12 months after hospitalization for COVID-19. Extended prophylactic Rivaroxaban therapy after hospital discharge could reduce new onset of AF and SCD in hospitalized COVID-19 survivors.</p>