Extended Thromboprophylaxis in Patients Hospitalized with COVID-19 at Time of Discharge from the Hospital Is Not Associated with an Improvement in Quality of Life: Results from the Activ 4c Clinical Trial

Introduction. Post-acute sequelae of SARS-CoV2 infection, or PASC, is defined as the presence of persistent symptoms for at least two months after an acute infection with COVID-19. A potential pathophysiologic mechanism for PASC is microvascular thrombosis. Using EQ-5D-5L index scores, we previously reported that extended thromboprophylaxis for 30 days with apixaban did not impact quality of life (QoL) at 30 or 90 days after discharge (Wang et al, Ann Intern Med 2023; 176:515-523). The purpose of this investigation was to determine whether anticoagulation had a variable impact on the individual domains measured by EQ-5D-5L. Methods. ACTIV 4c was a prospective, randomized, placebo-controlled, double-blind clinical trial comparing post-discharge thromboprophylaxis with apixaban 2.5 mg twice daily to placebo for 30 days in patients hospitalized with COVID-19. Participants were enrolled at 107 hospitals in the US between February 2021 and June 2022. We ascertained symptoms and QoL by EQ-5D-5L at 2 days, 30 days, and 90 days after hospital discharge by electronic or telephone follow-up. The five domains of EQ-5D-5L are: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each domain has 5 levels of response, ranging from “no problems/none” to “unable to perform/extreme”, which are used to determine individual scores. We analyzed the impact of treatment (placebo vs. apixaban), antiplatelet therapy (yes vs. no), and highest WHO severity score during hospitalization (score