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Post-Discharge Prophylactic Anticoagulation in COVID-19 Patients: A Clinical Dilemma
Prakrati Yadav1, Deepak Kumar1, Durga S Meena1
1Department of Internal Medicine, All India Institute of Medical Sciences Jodhpur,India.
Insights
Post-COVID-19 patients face risks of thromboembolism (TE). This study highlights complications from anticoagulant therapy and lack of prophylaxis, stressing the need for clear guidelines for managing TE in recovered patients.
Area of Science:
- Internal Medicine
- Cardiology
- Pulmonology
Background:
- The COVID-19 pandemic has significantly impacted global healthcare systems.
- Concerns exist regarding long-term complications in patients recovered from COVID-19.
- Thromboembolism (TE) is a recognized fatal complication in post-COVID-19 patients, with ongoing debate on optimal prophylaxis.
Observation:
- Three cases illustrate post-COVID-19 complications involving TE and anticoagulant therapy.
- A 60-year-old male experienced lower gastrointestinal bleeding while on rivaroxaban for COVID-19 pneumonia.
- Two other patients developed pulmonary thromboembolism (PTE) 2-3 months post-COVID-19 recovery without prior anticoagulant prophylaxis.
Findings:
- Complications arise from both COVID-19 itself and its treatment, including anticoagulant therapy.
- Pulmonary thromboembolism (PTE) can occur months after COVID-19 recovery in untreated patients.
- Inadequate post-discharge thromboembolism (TE) prophylaxis poses significant risks.
Implications:
- There is an urgent requirement for evidence-based guidelines on post-discharge TE prophylaxis for COVID-19 survivors.
- Clinical practice needs to address the risks of bleeding complications associated with anticoagulant use.
- Further research is essential to establish long-term benefits and safety of anticoagulant strategies in post-COVID-19 care.
Background:
COVID-19 pandemic has taken a great toll on the health care system worldwide. Along with the pandemic, there is also a concern regarding post COVID-19 complications in recovered patients. Thromboembolism (TE) has been reported as a fatal complication in recovered patients with COVID-19. There is still a great dilemma in post-discharge TE prophylaxis and its long-term benefits.
Case Description:
We reported three cases of post COVID-19 with complications related to both diseases as well as post discharge anticoagulant therapy. The first case is about a 60-yr-old male who developed Covid-19 pneumonia (moderate disease) and was discharged on rivaroxaban after initial improvement. 3 weeks later, the patient was readmitted with lower gastro-intestinal bleeding. The other two cases developed pulmonary thromboembolism within a span of 2-3 months (after recovered from COVID-19 pneumonia). Both these patients were not prescribed anticoagulants for TE prophylaxis.
Conclusion:
There is an imperative need for effective guidelines for post discharge TE prophylaxis in COVID-19.
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