Fiedler Lukas, Motloch Lukas J, Dieplinger Anna-Maria, Jirak Peter, Davtyan Paruir, Gareeva Diana, Badykova Elena, Badykov Marat, Lakman Irina, Agapitov Aleksandr, Sadikova Liana, Pavlov Valentin, Föttinger Fabian, Mirna Moritz, Kopp Kristen, Hoppe Uta C, Pistulli Rudin, Cai Benzhi, Yang Baofeng, Zagidullin Naufal
University Department of Internal Medicine II, Cardiology and Internal Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.
Department of Internal Medicine, Nephrology and Intensive Care Medicine, Hospital Wiener Neustadt, Wiener Neustadt, Austria.
Front Pharmacol. 2023 May 30;14:1093396. doi: 10.3389/fphar.2023.1093396. eCollection 2023.
While acute Coronavirus disease 2019 (COVID-19) affects the cardiovascular (CV) system according to recent data, an increased CV risk has been reported also during long-term follow-up (FU). In addition to other CV pathologies in COVID-19 survivors, an enhanced risk for arrhythmic events and sudden cardiac death (SCD) has been observed. While recommendations on post-discharge thromboprophylaxis are conflicting in this population, prophylactic short-term rivaroxaban therapy after hospital discharge showed promising results. However, the impact of this regimen on the incidence of cardiac arrhythmias has not been evaluated to date. To investigate the efficacy of this therapy, we conducted a single center, retrospective analysis of 1804 consecutive, hospitalized COVID-19 survivors between April and December 2020. Patients received either a 30-day post-discharge thromboprophylaxis treatment regimen using rivaroxaban 10 mg every day (QD) (Rivaroxaban group (Riva); = 996) or no thromboprophylaxis (Control group (Ctrl); = 808). Hospitalization for new atrial fibrillation (AF), new higher-degree Atrioventricular-block (AVB) as well as incidence of SCD were investigated in 12-month FU [FU: 347 (310/449) days]. No differences in baseline characteristics (Ctrl vs Riva: age: 59.0 (48.9/66.8) vs 57 (46.5/64.9) years, = .s.; male: 41.5% vs 43.7%, = .s.) and in the history of relevant CV-disease were observed between the two groups. While hospitalizations for AVB were not reported in either group, relevant rates of hospitalizations for new AF (0.99%, = 8/808) as well as a high rate of SCD events (2.35%, = 19/808) were seen in the Ctrl. These cardiac events were attenuated by early post-discharge prophylactic rivaroxaban therapy (AF: = 2/996, 0.20%, = 0.026 and SCD: n = 3/996, 0.30%, < 0.001) which was also observed after applying a logistic regression model for propensity score matching (AF: -statistics = 6.45, = 0.013 and SCD: -statistics = 9.33, = 0.002). Of note, no major bleeding complications were observed in either group. Atrial arrhythmic and SCD events are present during the first 12 months after hospitalization for COVID-19. Extended prophylactic Rivaroxaban therapy after hospital discharge could reduce new onset of AF and SCD in hospitalized COVID-19 survivors.
根据最新数据，虽然2019年冠状病毒病（COVID-19）急性期会影响心血管（CV）系统，但长期随访（FU）期间也报告了CV风险增加。除了COVID-19幸存者的其他CV病理情况外，还观察到心律失常事件和心源性猝死（SCD）风险增加。虽然关于该人群出院后血栓预防的建议存在冲突，但出院后短期利伐沙班预防性治疗显示出有前景的结果。然而，该方案对心律失常发生率的影响迄今尚未评估。为了研究这种治疗的疗效，我们对2020年4月至12月期间连续住院的1804例COVID-19幸存者进行了单中心回顾性分析。患者接受了两种治疗：一种是出院后使用利伐沙班10毫克每日一次（QD）进行30天的血栓预防治疗方案（利伐沙班组（Riva）；n = 996），另一种是不进行血栓预防（对照组（Ctrl）；n = 808）。在12个月的随访期内（随访时间：347（310/449）天），对新发心房颤动（AF）、新出现的高度房室传导阻滞（AVB）以及SCD的发生率进行了调查。两组之间在基线特征（Ctrl组与Riva组：年龄：59.0（48.9/66.8）岁 vs 57（46.5/64.9）岁，P = 0.35；男性：41.5% vs 43.7%，P = 0.51）和相关CV疾病史方面未观察到差异。虽然两组均未报告AVB住院情况，但在Ctrl组中观察到新发AF的相关住院率（0.99%，n = 8/808）以及SCD事件的高发生率（2.35%，n = 19/808）。出院后早期预防性利伐沙班治疗可减轻这些心脏事件（AF：n = 2/996，0.20%，P = 0.026；SCD：n = 3/996，0.30%，P < 0.001），在应用倾向评分匹配的逻辑回归模型后也观察到了这一结果（AF：z统计量 = 6.45，P = 0.013；SCD：z统计量 = 9.33，P = 0.002）。值得注意的是，两组均未观察到严重出血并发症。COVID-19住院后的前12个月内存在房性心律失常和SCD事件。出院后延长预防性利伐沙班治疗可降低住院COVID-19幸存者新发AF和SCD的发生率。
