Thrombosis and Bleeding Outcomes with Warfarin Conversion to Rivaroxaban during the COVID-19 Pandemic

Abstract

Introduction In 2020, during the coronavirus disease 2019 (COVID-19) outbreak, eligible patients were converted from warfarin to rivaroxaban to limit the transmission of COVID-19 infection. Methods A retrospective audit was performed which identified 190 participants with venous thromboembolism (VTE) and 112 participants with non-valvular atrial fibrillation (NVAF) at the Anticoagulation Clinic Service at Charlotte Maxeke Johannesburg Academic Hospital, South Africa. Participants were converted to rivaroxaban 20mg [Xarelto®, Bayer (Pty) Ltd, South Africa] for a median [interquartile range] period of 4 [2] months between April and October 2020. Follow-up was conducted telephonically and face-to-face on conversion back to warfarin. Rates of COVID-19 infections, bleeding and thrombosis were objectively confirmed. Results The rates of COVID-19 infection were 3.3% (n=10) [95% confidence interval (CI), 1.6 to 6.0] with 5 (1.7%) related hospital admissions and 2 (0.7%) related deaths (1 on rivaroxaban and 1 after switching back to warfarin). One-week after conversion to rivaroxaban, the rates of clinically relevant non major bleeding were 0.7% (95% CI, 0.02 to 2.54), and minor bleeding rates were 9.2% (95% CI, 6.16 to 13.40). There were no major bleeds. The bleeding rate was not significantly higher on rivaroxaban as compared to warfarin. There were 2 (0.7%) myocardial infarctions (1 on rivaroxaban and 1 after switching back to warfarin) and 1 (0.3%) 4 venous thrombosis presenting as a newly diagnosed first episode pulmonary embolism of a participant in the VTE group initially on enoxaparin and switched to rivaroxaban. Conclusion Conversion of eligible participants from warfarin to rivaroxaban during the first wave of the COVID-19 pandemic was associated with a low rate of recurrent thrombosis, major bleeding as well as COVID-19 infection.