Let’s face it. On the treatment front, the availability of specific drugs for Sars-CoV-2 virus infection to be used in the most serious cases has profoundly changed the treatment prospects of Covid-19. Because drugs can affect the evolution of the picture, when taken appropriately, even and above all in those who have serious heart problems and contract Covid.
For those at greater risk, perhaps due to frailty or age, being able to use Paxlovid and other treatments, from monoclonals to molnupiravir, has changed the prospects for treatment. But we must not forget that these are always drugs that can affect the action of other treatments that are being taken, perhaps to lower cholesterol or keep the blood fluid.
To take stock of this aspect by focusing attention on Paxlovid (nilmatrelvir-ritonavir) and any ongoing treatments should be considered. A reminder of this is a research coordinated by Sarju Ganatradirector of the cardio-oncology program at Lahey Hospital and Medical Center in Burlington, appeared on Journal of the American College of Cardiology. According to the expert, it should be remembered that those with cardiovascular risk factors may be more likely to develop Covid in a severe form and therefore must be protected with targeted pharmacological treatments. But it is equally important that the doctor and patients know the possible interactions between the treatments they are taking to reduce the risks of impacting cardiovascular well-being.
Covid: no, for the heart it is not just a flu
by Federico Mereta
Watch out for anticoagulant treatments
For every person with cardiovascular diseases, as the document explains, it is always necessary to consider the drugs that are taken before proceeding with the antiviral treatment, which is also very useful to reduce the risk of Covid19 evolving into a severe form. According to research reports, the association between nilmatrelvir and ritonavir is very effective in heart patients, but it can still have interactions with drugs used to control cardiovascular risk factors. In particular, experts report that caution should be exercised with agents that limit platelet aggregation, especially after the placement of a stent.
The available information speaks of a substantial safety for those on treatment with acetylsalicylic acid and prasugrel, while attention is needed if the antiviral drug is administered together with clopidogrel (increased risk of clot formation) or ticagrelor (in this case the problem appears linked to a potential risk of bleeding). The doctor can, case by case, indicate the most suitable treatment. Attention is also needed in the presence of warfarin treatments: an even more careful monitoring of the values of the parameters of the drug is recommended blood clotting.
Covid, this is how much the risk of heart attack, stroke and arrhythmias increases in the first month after infection
by Federico Mereta
What to do with anti-cholesterol and in case of arrhythmia
On the statin front, as far as is known at the moment, there may be higher risks of occurrence of muscle weakness and other muscle problems when taking simvastatin or lovastatin in combination with Paxlovid. for this reason it is advisable to suspend these treatments and in any case the opportunity is proposed to the cardiologist to reduce the dosages of the treatment for the reduction of LDL cholesterol even to those who are being treated with atorvastatin and rosuvastatin.
On the other hand, no specific problems are reported for those on treatment with other statins. Regarding rhythm disorders, it must be said that antiarrhythmic drugs, if administered together with the antiviral, could see their availability in the blood increase. For this reason, given the difficulty in discontinuing cardiovascular drugs in advance, it is still advisable to treat patients to evaluate alternative treatments in order not to create possible interference. Useful conclusions for everyone: do not forget to ask the cardiologist for advice in case of Covid-19 and treatments with specific drugs for Sars-CoV-2. A fine-tuning of the treatments can be useful to better deal with the situation.
The consequences of Covid on the heart. The alarm of the cardiologists
