Combination therapy with methylprednisolone and rivaroxaban for mild COVID-19 in Vietnam: laboratory and clinical insights

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Objective: To assess the efficacy and safety of methylprednisolone combined with rivaroxaban versus rivaroxaban monotherapy in mild cases of COVID-19. Methods: This quasi-experimental study was conducted at three hospitals in Ho Chi Minh City, Vietnam, from September 2021 to March 2022. Patients received either rivaroxaban 10 mg/day (Regimen 1) or methylprednisolone 16 mg/day plus rivaroxaban 10 mg/day (Regimen 2) for 7 days. Outcomes included progression to severe disease, adverse events, and changes in clinical and laboratory parameters. Statistical analysis employed Fisher's exact test and Generalized Estimating Equations (GEE). Results: Among 108 patients, no progression to severe disease or deaths occurred. Regimen 2 significantly improved laboratory markers, including white blood cell counts (+0.290; p<0.001), platelet counts (+0.102; p=0.032), aspartate aminotransferase (+0.335; p=0.013), alanine aminotransferase (+0.397; p=0.006) and CD4 cells (+0.458; p<0.001), and reduced activated partial thromboplastin time (-0.083; p=0.003) compared to Regimen 1. No significant differences in clinical symptoms were observed. Adverse events were rare, with one non-serious event reported in Regimen 1. Conclusion: Combination therapy with methylprednisolone and rivaroxaban enhanced immune and coagulation parameters without increasing adverse events. These findings suggest potential benefits of early intervention in mild COVID-19, warranting further research.

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