EFFICACY AND SAFETY OF APIXAN (APIXABAN) COMPARED WITH RIVAROXABAN IN COVID PATIENTS

Abstract

Background: Increased risk of thromboembolic manifestations associated with COVID-19 shown in recent literature. Several hypotheses have been suggested to understand the underlying pathophysiology behind development of a prothrombotic state in COVID-19 such as exaggerated inammatory response resulting in activation of the coagulation cascade and endothelial injury. Methods And Materials: It was a prospective observational study, conducted in three tertiary care Private Hospitals of Chattogram City in Bangladesh. The study enrolled 253 consecutive outpatients from June 01, 2021 to May 31, 2022 due to Covid-19 disease on the basis of presentation of signs and symptoms severity. Upon admission, routine investigations, treatment and follow-up were carried out. Study population divided into two groups. In Apixan group, used only one brand drug tab. Apixan 5 mg twice daily and in Rivaroxaban group, used different brand of drugs 10 mg daily. Results: Mean age of the patients was 54.3±7.3 years. Between two groups, the predominant co-morbidity among patients was hypertension (74.0% vs 73.8%), followed by diabetes mellitus (53.5% vs 60.3%). Cough (95.2% vs 94.4%) was the most common symptom at presentation, followed by fever (86.6% vs 88.0%) and Fatigue (30.7% vs 30.2%), among cases of COVID patients. Maximum patients were mild illness 81.1 % vs 76.9% and severe cases 3.1% vs 7.1% which were statistically signicant (p=0.046). Patients Apixan group received more ACEi/ARB (74% vs 73.8%), antiplatelet (22% vs 20.6%) and Rivaroxaban group received more anti-diabetic (60.3% vs 53.5%), Beta Blocker (56.3% vs 50.3%). All event rates were numerically higher in the rivaroxaban group of COVID-19 patients compared with apixan group. In the unmatched analysis, hypoxia/ Oxygen used 9 cases of Apixan group compared with Rivaroxaban group 24 cases (7.1% vs 19%, p- 0.005), Lower limb swelling (DVT) (3.9% vs 11.1%, p- 0.03) and others bleeding events (16.5% vs 26.1%, p-0.047) which were signicant. In the term of primary outcome after propensity score matching (PSM), there were no signicant differences in the risks of all-cause mortality (0.8% vs 1.6%, p-0.62), muscle spasm (47.2% vs 46%, p-0.847), fatigue (37% vs 43.7%, p0.28) and hospital admission (6.3% vs 9.5%, p- 0.34). Likewise, there were no signicant differences in the risk of myocardial infarction (MI) between both groups (1.5% vs 2.3%, p-0.85) and major bleeding (ICH/GI bleeding) (1.6% vs 3.9%, p-0.42). The risk of suffering an ischemic stroke/TIAat 90-days after medication was higher in Rivaroxaban group (0.8% vs 6.3%, p-0.02) which was clinically signicant. Conclusion: In conclusion Rivaroxaban may be associated with an elevated bleeding risk and Apixan (Apixaban) may be associated with a lower bleeding risk with lower other events