The primary efficacy outcome was not different between patients assigned therapeutic or prophylactic anticoagulation
Therapeutic group: 38.4% wins
Prophylactic group: 41.3% wins
Win ratio 0.86 (95% CI, 0.59 to 1.22); P = 0.40
Consistent results were seen in clinically stable and clinically unstable patients
The primary safety outcome occurred in more patients in the therapeutic group
Therapeutic group: 8%
Prophylactic group: 2%
Relative risk 3.64 (95% CI, 1.61 to 8.27); P = 0.0010
Therapeutic group: 1%
Prophylactic group: 1%
For hospitalized COVID-19 patients with elevated D-dimer levels, routine therapeutic anticoagulation did not provide a clinical benefit vs prophylactic anticoagulation and resulted in more bleeding episodes
The authors conclude
Thus, the use of therapeutic-dose rivaroxaban, and other direct oral anticoagulants, should be avoided in hospitalised patients with COVID-19 who do not have an evidence-based indication for oral anticoagulation
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