Direct Oral Anti-Coagulants (DOACs)

Last Review Performed on: April 20th, 2020

Direct Oral Anti-Coagulants (DOACs) are not recommended for use in treating COVID-19.

  • There are no studies supporting or arguing against using DOACs

Current Clinical Trials

  1. Preventing Cardiac Complications of COVID-19 Disease with Early Acute Coronary Syndrome Therapy: A Randomised Controlled Trial
    Study Location: Charing Cross Hospital, London, United Kingdom
    Intervention Arm: Aspirin 75mg daily, Clopidogrel 75mg daily, Rivaroxaban 2.5mg BID, Atorvastatin 40mg daily, Omeprazole 20mg daily

Peer-reviewed Publications

  1. Hunt B, A Retter, C McClintock. Practical Guidance for the Prevention of Thrombosis and Management of Coagulopathy and Disseminated Intravascular Coagulation of Patients Infected with COVID-19. Thrombosis UK. Mar 25, 2020. Retrieved from: https://thrombosisuk.org/downloads/T&H%20and%20COVID.pdf

    • Patients with severe COVID-19 have been shown to be at increased risk of VTE.

    • The optimal thromboprophylaxis in COVID patients is unknown.

    • Given the drug-drug interactions between antiviral agents and direct oral anticoagulants, patients should be switched to low molecular weight heparins (LMWH) or unfractionated heparins (UFH) with or without mechanical prophylaxis.

    • No studies cited analyzing the role of DOACs in COVID treatment/management.

      • Studies have focused on the role of heparin and enoxaparin.

  2. Thachil J, N Tang, S Gando, et al. ISTH Interim Guidance on Recognition and Management of Coagulopathy in COVID-19. J. Thromb. Haemost. Mar 25, 2020. Retrieved from https://doi.org/10.1111/jth.14810.

    • LMWH is noted to be the only widely available treatment for VTE Prophylaxis.

    • Anticoagulation with LMWH has been associated with better prognosis in relation to mortality.

    • No studies referenced analyzing the role of DOACs in COVID treatment/management.

      • Treatment recommendations focus sole on the use of enoxaparin.

  3. Zhang Y, M Xiao, S Zhang, et al. Coagulopathy and Antiphospholipid Antibodies in Patients with COVID-19. N Engl J Med. 2020 Apr 8. Retrieved from https://www.nejm.org/doi/full/10.1056/NEJMc2007575.

    • Case report of a patient with COVID-19 and clinically significant coagulopathy, antiphospholipid antibodies and multiple infarcts.

    • This is 1 of 3 patients with these findings from Peking Union Medical College Hospital in Wuhan, China.

    • Serologic tests in all 3 patients were positive for anticardiolipin IgA antibodies as well as anti-beta2-glycoprotein I IgA and IgG antibodies.

  4. Drug Interactions between DOACs and Antivirals:

    • HIV protease inhibitors are inhibitors of CYP3A4 and can increase plasma levels of apixaban and rivaroxaban. The effects of dabigatran and edoxaban are not known.

    • Reference: Vranckx P, M Valgimigli and H Heidbuchel. The Significance of Drug-Drug and Drug-Food Interactions of Oral Anticoagulants. Arrhythm Electrophysiol Rev. 2018 Mar; 7(1): 55-61.