Extended Thromboprophylaxis in Patients Hospitalized with COVID-19 at Time of Discharge is Not Associated with Improvement in Quality of Life.

BACKGROUND: The long-term effects of COVID-19, known as post-acute sequelae of SARS-CoV-2 infection (PASC), impair quality of life (QoL). This secondary analysis of the ACTIV-4c clinical trial evaluates the specific effects of extended thromboprophylaxis with apixaban on individual QoL domains, assessed by EQ-5D-5L index, in patients discharged after COVID-19 hospitalization. METHODS: ACTIV-4c study was a prospective randomized, placebo-controlled, double-blind clinical trial. We enrolled 1,217 patients hospitalized with COVID-19 at 107 U.S. hospitals between February 2021 and June 2022. Participants were randomized to apixaban 2.5 mg twice daily or placebo for 30 days post-discharge. QoL was assessed using EQ-5D-5L index at 2, 30, and 90 days post-discharge, evaluating five domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Data were analyzed using chi-square tests and proportional odds models adjusted for multiple variables. RESULTS: Of 1,217 participants, 610 received apixaban and 607 received placebo. By 2 days post-discharge, 43.5% of apixaban and 45.0% of placebo recipients reported moderate impairment in one or more EQ-5D-5L domains, particularly usual activities (33.0%). At 30 days, moderate impairment persisted in 30.8% of apixaban and 33.4% of placebo recipients, improving most in the usual activities domain (17.4%). At 90 days, 31.5% of apixaban and 28.5% of placebo recipients reported moderate impairment. Extended thromboprophylaxis with apixaban was not associated with significant improvements in any EQ-5D-5L domains at 30 or 90 days. CONCLUSIONS: Extended thromboprophylaxis with apixaban after COVID-19 hospitalization does not improve QoL. The high prevalence of QoL impairment highlights the need for targeted interventions for PASC.

Duke Scholars

Author Thomas Lee Ortel Medicine, Hematology

Author Kevin J. Anstrom Biostatistics & Bioinformatics, Division of Biostatistics