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Thrombosis and bleeding outcomes with warfarin conversion to rivaroxaban during the COVID-19 pandemic

C-Y Wang1, E Schapkaitz1, S Louw1

  • 1Division of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde
|December 11, 2025
PubMed

Insights

During the COVID-19 pandemic, patients switched from warfarin to rivaroxaban showed similar bleeding and thrombosis rates. This study offers insights for managing anticoagulation during public health crises.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • The COVID-19 pandemic necessitated changes in patient management, including switching anticoagulation therapy.
  • Warfarin to rivaroxaban conversion was implemented to reduce COVID-19 transmission risk.

Purpose of the Study:

  • To evaluate thrombosis and bleeding outcomes in patients switched from warfarin to rivaroxaban during the COVID-19 pandemic.
  • To provide data for managing anticoagulation in future public health emergencies.

Main Methods:

  • A retrospective audit of 190 venous thromboembolism and 112 non-valvular atrial fibrillation patients converted to rivaroxaban.
  • Follow-up assessments included telephone and face-to-face interviews, with objective confirmation of COVID-19 infections, bleeding, and thrombosis.
  • Patients were treated with rivaroxaban 20 mg for a median of 4 months during April-October 2020.

Main Results:

  • The COVID-19 infection rate was 3.3%, with 1.7% hospital admissions and 0.7% COVID-19-related deaths.
  • No major bleeding events occurred; clinically relevant non-major bleeding was 0.7% and minor bleeding was 9.2%.
  • Bleeding rates on rivaroxaban were not significantly higher than on warfarin; one pulmonary embolism and two myocardial infarctions were reported.

Conclusions:

  • Converting patients from warfarin to rivaroxaban during the COVID-19 pandemic was associated with acceptable safety and efficacy outcomes.
  • Findings offer practical insights for anticoagulation management during public health crises.
  • The study informs future interventions in similar emergency settings.
Abstract

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