Mount Sinai Med-Lit Review
Clinical question: Among patients with provoked venous thromboembolism (VTE) and ongoing risk factors, does extending anticoagulation with low-dose apixaban reduce recurrence?
Background: Provoked VTE is typically treated with three months of anticoagulation, but patients with ongoing risk factors such as obesity, chronic lung disease, atherosclerotic cardiovascular disease, or autoimmune disease may remain at higher risk for recurrence. Evidence guiding extended therapy in this group has been limited.
Study design: Randomized, double-blind, placebo-controlled trial
Setting: Single-center, outpatient trial at Brigham and Women’s Hospital
Synopsis: This trial randomized 600 patients with provoked VTE and persistent risk factors who had completed at least three months of anticoagulation to either low-dose apixaban (2.5 mg twice daily) or placebo for another year. Recurrent VTE occurred less often with extended apixaban than with placebo (1.3% versus 10%; hazard ratio [HR], 0.13; 95% confidence interval [CI], 0.04 to 0.36). Major bleeding was rare and did not differ significantly between groups, although clinically relevant nonmajor bleeding was numerically more frequent with apixaban. Limitations include the single-center design and limited power to evaluate outcomes across specific risk factors.
Bottom line: In selected high-risk patients with provoked VTE, extended low-dose apixaban substantially reduces recurrence with a low risk of major bleeding.
Citation: Piazza G, et al. Apixaban for extended treatment of provoked venous thromboembolism. N Engl J Med. 2025;393(12):1166-1176. doi: 10.1056/NEJMoa2509426.
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Dr. Canas
Dr. Canas is a hospitalist in the department of medicine at Mount Sinai Hospital and an assistant professor of medicine at the Icahn School of Medicine at Mount Sinai, both in New York.
