Atrial fibrillation is a frequent complication among patients with severe coronavirus disease-2019 (COVID-19) infection Both direct and indirect mechanisms through COVID-19 have been described to explain this relationship COVID-19 infection increases the risk of developing both arterial and venous thrombotic complications through systemic coagulation activation, leading to increased mortality Chronic oral anticoagulation is essential to reduce the thromboembolic risk among AF patients Switching to low-molecular-weight heparin has been recommended during hospitalization for COVID-19 infection Of note, at discharge, the prescription of direct oral anticoagulants may offer some advantages over vitamin K antagonists However, oral anticoagulants should only be prescribed after the consideration of drug-drug interactions with antiviral therapies as well as of the risk of hepatotoxicity, which is common among individuals with severe COVID-19 pneumonia Not all anticoagulants have the same risk of hepatotoxicity;dabigatran has shown a good efficacy and safety profile and could have a lower risk of hepatotoxicity Furthermore, its metabolism by cytochrome P450 is absent and it has a specific reversal agent Therefore, dabigatran may be considered as a first-line choice for oral anticoagulation at discharge after COVID-19 infection In this review, the available information on the antithrombotic management of AF patients at discharge after COVID-19 infection is updated In addition, a practical algorithm, considering renal and liver function, which facilitates the anticoagulation choice at discharge is presented
Dabigatran, the oral anticoagulant of choice at discharge in patients with non-valvular atrial fibrillation and COVID-19 infection: the ANIBAL protocol