There are several ways in which the COVID-19 pandemic may affect the prevention and management of thrombotic and thromboembolic disease, either direct effect or the indirect effects of infection, such as through severe illness and hypoxia, may predispose patients to thrombotic events. The severe inflammatory response, critical illness, and underlying traditional risk factors may all predispose to thrombotic events. Therefore, considering the high-risk profile of cardiovascular comorbidities in patients with COVID-19, it is scientifically relevant to evaluate the use of anticoagulants as an adjunctive treatment in the context of COVID-19. Indeed, it will be tested the hypothesis that the use of moderate dose of rivaroxaban has a beneficial effect in the treatment of patients with a confirmed or probable diagnosis of COVID-19 infection, with no clear indication for hospitalization (mild and moderate cases) upon initial medical care, by reducing the need of hospitalization due to complications related to COVID-19.
Initial studies suggest an inflammatory state and hypercoagulation in individuals with COVID-19. Apparently, the fact that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein binds to Angiotensin Converting Enzyme 2 (ACE2) receptors can lead to ACE2 depletion by SARS-CoV-2 favoring the "harmful" ACE1 / angiotensin II and promoting tissue damage, including stroke. Recent observational studies indicate a higher rate of thromboembolism in patients with COVID-19, especially those in severe condition. They also report that, in patients treated with anticoagulants, complication rates were lower as compared with those not receiving anticoagulant therapies. More recently, in a post-mortem study of patients with Covid-19 compared to recently published cases of influenza, the histopathological pattern on the periphery of the lungs of patients with Covid-19 revealed a diffuse alveolar lesion with infiltration of perivascular T cells and other vascular aspects, consisting of severe endothelial damage (endothelitis) associated with the presence of intracellular viruses and broken cell membranes. In addition, pulmonary vessels showed generalized thrombosis with microangiopathy, and alveolar capillary microthrombi were much more frequent in patients with COVID-19 than with severe influenza respiratory conditions.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
660
Rivaroxaban pharmaceutical form will be tablets of 10 mg
Hospital Maternidade São Vicente de Paulo
Barbalha, Ceará, Brazil
Clínica Senhor do Bonfim
Feira de Santana, Estado de Bahia, Brazil
Hospital de Base do Distrito Federal
Brasília, Federal District, Brazil
Hospital de Campanha Covid-19 Goiânia/Sesgo
Goiânia, Goiás, Brazil
Hospital Estadual de Urgências de Trindade/SESGO
Trindade, Goiás, Brazil
Venous thromboembolic events (VTE)
Defined as deep venous thrombosis, acute pulmonary embolism, other major venous thrombotic events.
Time frame: Within 30 days from randomization
Mechanical ventilation free-survival
Defined as survival without requirement of mechanical ventilation.
Time frame: Within 30 days from randomization
Major Adverse Cardiovascular Events (MACE)
Defined as acute myocardial infarction, stroke or acute limb ischemia
Time frame: Within 30 days from randomization
Out-of-hospital death not attributed to major injury
Death that occurred out of hospital due to any cause not related to trauma or other major injury
Time frame: Within 30 days from randomization
Time from randomization to hospitalization
Defined as time elapsed since randomization to hospital admission
Time frame: 30 days from randomization
Length of Hospitalization
To assess the duration of hospitalization (length of hospital stay)
Time frame: 30 days from randomization
Hospitalization in Intensive Care Unit
Requirement of admission to ICU for intensive care
Time frame: 30 days from randomization
Clinical requirement of mechanical ventilation
Requirement of oxygen supplementation through invasive or non invasive mechanical ventilation.
Time frame: 30 days from randomization
Clinical duration of mechanical ventilation
Total time on oxygen supplementation through invasive or non invasive mechanical ventilation
Time frame: 30 days from randomization
Composite vascular endpoint I
Non-fatal myocardial infarction, non-fatal ischemic stroke or cardiovascular death, VTE
Time frame: 30 days from randomization
Composite vascular endpoint II
Cardiovascular death, non-fatal myocardial infarction, non-fatal ischemic stroke or acute limb ischemia, VTE
Time frame: 30 days from randomization
Major Bleeding
Defined by International Society of Thrombosis and Hemostasis (ISTH) criteria
Time frame: 30 days from randomization
Mortality
Defined by all-cause deaths
Time frame: 30 days from randomization
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Hospital São Lucas
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...and 26 more locations