Outpatient Antithrombotic Therapy Following Revascularization for COVID-Associated Peripheral Arterial Thrombosis

Acute limb ischemia (ALI) during the acute phase of coronavirus infection - an urgent complication, associated with a high rate of adverse events. Antithrombotic therapy remains the cornerstone of prevention and treatment of thrombotic complications in patients with COVID-19. The aim of study was to evaluate the effectiveness of combined outpatient antiplatelet and anticoagulant therapy compared with antiplatelet monotherapy during the 12-month postoperative period after arterial revascularization in the acute phase of coronavirus infection. Materials and Methods: The study included 257 patients. Group I (control; n = 100) comprised patients without a history of COVID-19, while Group II (study; n = 157) included patients with laboratory-confirmed acute coronavirus infection. Patients in Group I received an antiplatelet agent (aspirin 100 mg once daily). Patients in Group II were prescribed outpatient combination therapy after revascularization: an antiplatelet agent (aspirin 100 mg once daily) and an anticoagulant (rivaroxaban 10 mg once daily for 30–45 days, followed by 2.5 mg twice daily). The results demonstrated a significant reduction in the rates of limb amputation and recurrence of ALI among Group II patients with a history of COVID-19 who received combination therapy with rivaroxaban and aspirin, consistent with findings from the COMPASS study. SF-36 scores improved significantly, approaching the quality-of-life levels observed in patients without a history of COVID-19. Conclusion: The findings support the feasibility of routine use of combined antiplatelet and anticoagulant therapy in the outpatient setting for up to one year after revascularization for ALI in the context of the COVID-19 pandemic.