Apixaban was prescribed in India during the first two Covid-19 waves. Doctors say it is now prescribed only to high-risk patients.
Representative picture of anticoagulant drugs. Clinical trial found that the anticoagulant Apixaban, prescribed during Covid 19 is ineffective and in rare cases dangerous too.
Indian doctors on Tuesday, 29 November, woke up to the news of research on a blood thinning drug — one that was widely administered to Covid-19 patients — to be not working and having serious side effects.
A study conducted by the UK government-funded initiative “Heal Covid Trial” found that Apixaban, the drug in question, can cause severe bleeding.
However, doctors South First spoke to had mixed opinions and said that more research might be needed to arrive at a conclusion.
Dr Ravindra Mehta, a pulmonologist at Apollo Hospitals in Jayanagar in Bengaluru told South First, “This medication was commonly used for Covid-19 because of three reasons. One, it was an unknown disease. Second, it was much more common than pneumonia. The third was the vascular involvement of Covid-19, which led to the formation of what is called a blood clot or thrombi.”
He explained: “In such cases, some high-risk people were put on these blood thinners because their condition was suddenly worsening and the clots were much more. Also, various reports showed that it might make a difference. That was the science.”
The HEAL-COVID trial (Helping to Alleviate the Longer-term consequences of COVID-19) is funded by the National Institute for Health and Care Research (NIHR) and the Cambridge NIHR Biomedical Research Centre.
More than a thousand patients from the National Health Service were part of the trial.
The initial trial data showed that Apixaban had a 29.1 percent reduction in death or readmission as opposed to 30.8 percent in standard care.
The drug had serious side effects in the 402 subjects who received it.
The therapy caused major bleeding that led to the discontinuation of the treatment in these patients.
Indian doctors confirmed that this particular drug was a part of the treatment process, especially during the first and second waves of Covid-19.
They, however, said it was used on a temporary basis and hence didn’t cause complications in the cases they saw.
They added that more research was needed on the chronic phase of Covid-19 and how to treat it.
“There were few cases where patients were prescribed drugs — including steroids — unnecessarily, so they may have experienced these. However, since in my practice the prescriptions were only in cases that needed it and also for very short durations, we didn’t see any complications as such,” Mehta explained.
Noted pulmonologist Dr Satyanarayana Mysore, the HoD of Sleep Medicine at Manipal Hospitals in Bengaluru, called this study misleading.
He explained, “This new study is most welcome. However, the study is kind of misleading on many fronts. The Covid-19 virus was a novel one. Every country and every doctor went through a huge learning curve to understand the disease. What was once an established guideline based on presumed evidence and logic is defunct currently. This study needs to be looked at on that note.”
Mysore said the anticoagulant drug was used rampantly during the first and second waves of Covid-19 in India. However, it was used only on selective patients by the third and fourth waves.
He said, “In the first and second waves, anticoagulation use was widespread. By the time we reached the third wave, it was used only on patients who were at high risk. In the fourth wave, it was the same story: selective offering to patients who needed it based on their clot risks.”
Given such conditions, the study didn’t show anything other than substantiating the practice pattern that exists currently, he added.
Meanwhile, agreeing that this drug had been used rampantly in post-Covid-19 patients to prevent coagulation or clot formations, Dr Rohan Krishna, president of the Federation of All India Medical Association (FAIMA), said this study was a very important one because it was giving a result that was contrary to the usual medical practice.
“It has been seen that Covid-19 is causing Deep Vein Thrombosis and pulmonary embolism in which the treatment of choice is blood thinners, which is being prescribed by most of us. Even the guidelines by the Central government mention this,” he said.
“So, I think this result is a very important one as every drug has its own side effects and a few of the drugs such as Apixaban has continuous bleeding says the study. If it’s not much of use, then such drugs should not be prescribed,” asserted Krishna.
He also called for more research to be done on post-Covid-19 treatment protocols.
He said: “Now that the pandemic’s infectious phase is over, we must look into the chronic phase of the pandemic and what are some of the long-term effects of Covid-19, and also the medications being used for it.
Krishna added: “We need to look at the problems associated with the disease and how to treat it. A holistic view and research are awaited. This is very important.” he added.
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