Rivaroxaban vs. Aspirin to Prevent Recurrent Venous Thromboembolism

The duration of guideline-recommended antithrombotic therapy for patients with venous thromboembolism (VTE) ranges from 3 months to indefinite, depending on whether the VTE is provoked or unprovoked and on patients' bleeding risks (NEJM JW Emerg Med Feb 2016 and Chest 2016; 149:315). For long-term prevention of recurrent VTE, options include warfarin, direct-acting oral anticoagulants, and aspirin; among the anticoagulants, guidelines recommend direct-acting anticoagulants over warfarin, unless substantial renal impairment is present. Indirect comparisons suggest that direct-acting oral anticoagulants are more effective than aspirin but are more likely to cause serious bleeding. Now, we have a head-to-head, randomized, double-blind trial.

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