Remdesivir use in severe and critical COVID-19 patients might be associated with lower incidence of arterial thrombotic events

• Published in: The American journal of emergency medicine Vol. 70; pp. 41 - 45
• Main Authors: Lucijanic, Marko, Bistrovic, Petra, Jordan, Ana, Mihaljevic, Iva, Bukvic, Stela, Kovacevic, Stjepan, Ranilovic, Darjan, Sakota, Sara, Vlasac Glasnovic, Josipa, Delic-Brkljacic, Diana
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2023; Elsevier Limited
• Subjects: Adenosine; Antiviral drugs; Arterial thrombosis; Cardiac arrhythmia; Clinical outcomes; Comorbidity; COVID-19; Critical; Drug dosages; Emergency medical care; Hospitalization; Inflammation; Laboratory methods; Medical imaging; Medical prognosis; Pulmonary arteries; Remdesivir; Severe; Thromboembolism; Thrombosis; Venous thrombosis; COVID-19; Arterial thrombosis; Remdesivir; Critical; Venous thrombosis; Severe
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2023.05.007

Venous thromboembolism (VTE) and arterial thrombotic (AT) events are a striking feature of severe COVID-19, however, relationship of remdesivir use and the risk of thrombotic events is unknown and has not been investigated before. We retrospectively analyzed a cohort of 876 consecutive hospitalized severe and critical COVID-19 patients who were treated with remdesivir and compared them to 876 case-matched control patients. All patients were treated in our tertiary-level institution in period from 10/2020 to 6/2021. VTE and AT were diagnosed by objective imaging and laboratory methods. After exclusion of 71 VTE and 37 AT events present at the time of hospital admission, there were a total of 70 VTE (35 in the remdesivir and 35 in the control group) and 38 AT events occurring during hospitalization (13 in the remdesivir and 25 in the control group). There was a similar cumulative post-admission VTE incidence among both remdesivir and matched control patients (P = 0.287). Significantly lower cumulative post-admission AT incidence was observed among patients treated with remdesivir than among matched control patients (1.7% vs 3.3%, HR = 0.51, P = 0.035). Tendency for lower AT rates was evident in subgroups of patients stratified according to the type of AT, as well as according to the intensity of required oxygen supplementation at the time of remdesivir use. Remdesivir use in severe and critical COVID-19 patients might be associated with lower occurrence of AT during hospitalization, whereas similar rates of VTE events were observed among both patients treated with remdesivir and control patients. •Relationship of remdesivir use with the risk of thrombotic events in severe COVID-19 patients is unknown.•Lower AT and similar VTE rates were present among patients treated with remdesivir in comparison to control patients.•Lower AT rates were present across subgroups of patients with different type of AT and different oxygen requirement.