Extended VTE Prophylaxis with Apixaban Not Superior to Shorter-Course Enoxaparin

In medical patients, continued use of the factor Xa inhibitor apixaban as thromboprophylaxis after hospitalization was no more effective than enoxaparin, which is usually discontinued at discharge. In addition, apixaban more than doubled the rate of major bleeding events, according to a New England Journal of Medicine report.

The international double-blind study was sponsored by apixaban's manufacturer.

Some 4500 hospitalized medical patients at risk for thromboembolism underwent randomization to apixaban for 30 days or enoxaparin for 6 to 14 days. After 30 days, the groups' rates of thromboembolic events were similar, but major bleeds occurred twice as often with apixaban (0.47%) as with enoxaparin (0.19%).

Given that thromboembolic risks extend beyond hospital discharge, the authors call for better risk stratification "to identify a narrower spectrum of medically ill patients who may benefit from extended prophylaxis."